Evidence-Based Project Yields Practice Change in Emergency Department

Sigma Theta Tau International Leadership Conference 2016

Poster Abstract

Beth K. Hurwitz, RN,BSN, CEN

The various methods of pediatric patient temperature measurement have long been debated by those providing care in the emergency department (ED). The gold standard has been the rectal temperature (RT). While accurate, this method causes distress to patients and their families, and adds significant time to the triage process. Prior to this project, children with non-infectious complaints such as fractures or lacerations were being subjected to rectal temperature measurement, causing undo stress. Other methods of temperature measurement such as temporal artery, tympanic, axillary, and infrared have been studied to determine their efficacy and accuracy.

In response to this growing dilemma of best practice, a group of emergency department staff nurses from a multihospital system identified an opportunity for improvement which lead them to undertake an evidence-based practice project that included an exhaustive literature search, review of relevant studies, creation of a table of evidence, presentation of findings, and recommendations for practice change. During the search, the committee found that in February 2008, the Society of Pediatric Nurses released a position statement that stated that temporal artery thermometry (TAT) provided accurate temperature measurement in infants greater than 90 days without fever as well as all patients over 3 months with or without fever (Asher & Northington, 2008). In addition, in 2011, the Emergency Nurses Association (ENA) completed its own comprehensive literature review (2011). They identified that in children younger than 24 months, TAT and RT measurements were highly correlated. Staff used this as a starting point for finding an answer to this practice problem. The project resulted in the adoption of guidelines for use of temporal artery thermometry as a screening tool for pediatric patients older than ninety days that present without infectious complaints. Nursing, patient and family satisfaction data was tracked over a 9 month period using post-implementation surveys.

This poster describes a staff-lead evidence-based practice project to determine whether temporal artery thermometry would provide safe, consistently accurate measurement during triage, increase triage throughput times, and increase patient and nurse satisfaction during the triage process.