Therapeutic Hypothermia Improvement Project

Friday, 28 July 2017

Shiao-Pei Wang, MSN
Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan


Therapeutic hypothermia (TH) is a standard care of post-cardiac arrest (CA), several studies have showed that TH can improve anoxia neurological outcomes. According to the evidence, TH should be initiated as soon as possible after CA. However, TH is a complicated and labor intensive treatment. Therefore, in order to enhance the efficacy of TH, we must shorten the time from return-of-spontaneous circulation (ROSC) after CA to initiation of TH and improve the integrity of nursing care process.


Improvement project:
1. Form a trans-unit TH team
2. Renew and propose TH operational process and nursing care practice standards
3. Put medical treatments into a doctor’s order package
4. Develop a nursing care checklist include all nursing care activities
5. Held in-service education

Project implementation:
1. A trans-unit TH team was formed which included attending physician, residents, clinical nursing staff and administrator of emergency department and
intensive care unit, one pharmacist also involved in this team. Team members met once a month and discussed the difficulties of TH in practice.
2. Renewed and proposed the TH operational process and nursing care practice standard, which approved by
department and became a formal practice guideline. The shared decision making concept was applied into the process
while physician explained TH to patient’s family.
3. Put all medical treatments into a doctor’s order package and made it more convenient when doctor prescribed TH
orders and reduced missing.
4. Developed and integrated all nursing care activities into a nursing care checklist, avoiding incomplete nursing
5. ED and ICU physicians and nurses undergo at least one hour education about TH, and advocated the new TH
protocol and nursing care practice guideline.


The time from ROSC after CA to initiation of TH was shortened from 151 minutes to 122 minutes. The time from ROSC after CA to target temperature was shortened from 431 minutes to 316 minutes. Care completeness increased from 81.5% to 95%.


Through the trans-unit cooperation, this improvement project shortened the time from ROSC to initiation of TH, time from ROSC to target temperature and improve care completeness successfully. Besides, medical staff had increased knowledge about TH. In the future, we should parallel promote TH protocol and care standard to other ICU.