By Betsy Todd, MPH, RN, CIC, AJN clinical editor
Do you dread taking rectal temperatures in pediatric patients, knowing that your action will leave you with a screaming, distrustful child as well as a distressed parent? Rectal temperature measurements have long been considered the “gold standard” for accuracy. But are they essential in very young children, especially when infection is not suspected?
“Improving Pediatric Temperature Measurement in the ED” in our September issue relates how a group of ED nurses explored possible alternatives to routine rectal temperature measurements during triage. Their ED protocol had been to use this method in all children under the age of five. However, this practice extended the time needed for triage, was often upsetting to parents, and seemed potentially unnecessary when the reason for the ED visit did not suggest infection (where there would be a need for more careful fever assessment).
An existing emergency services committee made up of ED staff nurses from the hospital’s two campuses set out to explore their options. The committee’s first move was to clearly define the practice problem:
Using PICOT format (Patient population, Intervention of interest, Comparison intervention, Outcome, Time frame), the committee initially formulated the following clinical question: For pediatric patients younger than five years of age (P) who require temperature measurement (I), what is the safest method of measurement (C) to achieve consistently reliable temperature measurement (O) in the triage process (T)?
Under the guidance of an advanced practice nurse, they performed a literature search for relevant articles and guidelines and consulted local pediatric specialty hospitals about their practices. Nursing administrators provided paid release time to committee members so that part of the nurses’ work on this QI project could be done during work hours.
This was their committee’s first evidence-based practice project, and while there were glitches, some communication issues, an unfilled educator position on one campus, and plenty of hard work along the way, the nurses moved their practice forward and were very positive about the experience:
“We believe our experience and our success offer encouragement to nurses in other hospitals to improve and refine their practice through similar evidence-based QI initiatives.”