Temperature Monitoring Across the Patient Pathway | A Case for Standardisation and Sustainable Improvement

Temperature monitoring is a critical component of patient care throughout the surgical journey.  As NHS Supply Chain renews the Patient Temperature Management framework, for a Mid- 2027 launch, practices vary across NHS Trusts. Consistent temperature monitoring is essential throughout the surgical pathway, yet differing systems create inefficiencies.

As part of the wider Patient Temperature Management category team, Raymond Pukacz Clinical Engagement and Implementation Manager, here at NHS Supply Chain, proposes a simple but impactful idea:

Standardising to a single, continuous core-temperature monitoring method across the entire patient pathway.  

We believe this could improve clinical outcomes, reduce waste, lower costs, and support national sustainability and procurement priorities.
We invite NHS trusts to help validate this approach. To get involved, please contact the Patient Temperature Management Category Team:

On the ward, tympanic thermometers are commonly used. These measure temperature at the tympanic membrane, which reflects core body temperature due to its arterial blood supply. However, accuracy can be compromised by factors such as ambient temperature, sensor placement, and ear conditions (e.g., wax, infection, or foreign bodies). Additionally, disposable probe covers are required for each patient to prevent cross-contamination.
In the operating theatre, more accurate core temperature monitoring is achieved using devices such as:

• General probes – nasopharyngeal or rectal
• Foley catheters with integrated temperature sensors
• Oesophageal stethoscopes with temperature probes
• Heat-flux (deep forehead) sensors.

This shift in devices between departments, bedside to theatre and back, creates inconsistency and limits the continuity of patient monitoring.

Introducing a non-invasive core-temperature monitoring system, such as a zero heat-flux sensor, earlier in the pathway (e.g., on the ward) the ward could streamline the entire process. This approach would:

• Provide continuous and consistent readings from the ward to the theatre and recovery
• Reduce device switching and variability in measurement
• Improve patient comfort and reduce clinical errors
• Support proactive warming protocols to maintain normothermia (36.6˚C – 37.5˚C).

*Product names referenced in this blog, such as Temple Touch Pro and Zero Heat‑Flux systems, are included only as examples of the types of continuous core‑temperature monitoring technologies currently available. Other equivalent products and technologies may offer similar functionality and benefits. NHS Supply Chain remains supplier‑agnostic, and trusts should evaluate all appropriate solutions in line with their clinical, operational, and procurement requirements.

¹NICE Clinical Guideline CG65 on hypothermia prevention and management highlights the need for accurate core‑temperature measurement and regular monitoring throughout the surgical pathway.

Temperature should be recorded:

• Within one hour before leaving the ward or the Emergency Department
• Before induction of anaesthesia and every 30 minutes during surgery
• on arrival or in admission to recovery and every 15 minutes thereafter
• On return to the ward and every four hours subsequently.

Patients should ideally have a temperature of ≥36°C before entering theatre (according to NICE Guidelines) unless urgent clinical circumstances dictate otherwise.

Probe covers may seem inexpensive, but collectively they represent a major cost and environmental burden:

• 1,296 tonnes of plastic waste generated – *The same weight as 1,000 small cars
• Over 4,100 tonnes of CO₂e from material use – **Equal to the annual electricity use of 700+ UK homes.

Tympanic thermometers also carry replacement and WEEE‑compliant disposal costs. While some trusts receive free‑of‑charge devices, they must still purchase covers.
Reducing reliance on probe covers supports the NHS’s net‑zero ambitions and removes avoidable waste, cost, and storage demands.

**The figures below are calculated using NHS Supply Chain national usage and spend data for a 12‑month period (latest full year at time of analysis), combined with 2025 UK Government Greenhouse Gas Conversion Factors and the NHS “Activity‑based emission factors for Greenhouse Gas modelling in the NHS v1.5” (December 2025). All volumes, spend values and CO₂e calculations reflect data available at the time of publication.

Across clinical environments, temperature monitoring practices have been shaped by years of experience, routine, and the realities of busy wards and theatres. It’s understandable that introducing changes can feel challenging. Teams often highlight:

• Existing workflows that are already working
  “We’ve always done it this way.”
• Pressures on staff time and capacity
  “This increases my budget while theatres save.” (silo mentality).
• Budget responsibilities are split across departments
  “We don’t have time to implement new systems on their spending.”
• Concerns about adopting new equipment during high activity
  “Change is difficult; this has been our standard for years.”

These are all valid reflections of the current system, not resistance to improvement. They show how committed clinical teams are to maintaining safe, reliable care.

Using a single monitoring method, the same type already used in theatres, simply brings it forward in the pathway. This offers a constant, reliable core‑temperature reading, enabling clinicians to intervene sooner and maintain patient warmth more easily, as recommended by NICE.

Adopting a single, continuous temperature monitoring system such as the ‘Temple Touch Pro’ or ‘Zero Heat-Flux Sensor’, from the ward through to operating theatres and back to the ward:

• Improve clinical efficiency
• Support better patient outcomes
• Reduces environmental impact
• Aligns with value-based procurement and patient care models.
• Supports the reduction of Surgical Site Infection (SSI) risk
• Maintain compliance with NICE guidelines.

Temperature is a key contributor to SSI risk. Hypothermia affects immune function and wound healing, and maintaining normothermia remains a core element of SSI prevention bundles.
Despite this, guidelines still vary on the exact thresholds for normothermia and when temperature management should begin. With SSIs estimated to cost the NHS around £700 million a year, improving temperature management offers both clinical and economic value.

We are seeking interested trusts to help quantify the sustainability benefits and assess patient outcomes associated with this approach to continuous temperature monitoring across the patient pathway.
Please contact the Patient Temperature Management Category Team to be part of this collaboration.

• High impact intervention. Care bundle to prevent surgical site infection. London; Department of Health; 2011 (http://hcai.dh.gov.uk/files/2011/03/2011-03-14-HII-Prevent-Surgical-Site-infection-FINAL.pdf, accessed 6 May 2016).
• Targeted literature review: what are the key infection prevention and control recommendations to inform a surgical site infection (SSI) prevention quality improvement tool? Edinburgh: Health Protection Scotland; version 2.0 December 2012 (http://www.documents.hps.scot.nhs.uk/hai/infection-control/evidence-for-care-bundles/literature-reviews/ssi-review.pdf, accessed 6 May 2016).
• Owens P, McHugh S, Clarke-Moloney M, Healy D, Fitzpatrick F, McCormick P, et al. Improving surgical site infection prevention practices through a multifaceted educational intervention. Ir Med J. 2015;108:78–81. [PubMed]
• Leaper DJ, Tanner J, Kiernan M, Assadian O, Edmiston CE, Jr. Surgical site infection: poor compliance with guidelines and care bundles. Int Wound J. 2015;12:357–62. [PMC free article] [PubMed]
• ** All figures exclude VAT**