Reducing Antipyretic Use for Lowgrade Fevers in Otherwise Healthy Children
The purpose of this evidence-based practice project was to identify knowledge among pediatric emergency nurses about the benefits and myths of fever in otherwise healthy children and to decrease the use of antipyretics to allow for normal physiologic response in lowgrade fevers.
Background
Fever phobia remains a prominent issue in the pediatric population, with fever being the primary chief complaint for after-hours calls, sick office visits, and urgent care and emergency department utilization. Fever phobia exists in both parents and healthcare providers, as evidenced by the quest to return the child to a state of normothermia. While most infants and children will experience fever at some point, fevers under 38.5ºC (101.3ºF) are considered benign in those who are healthy. Therefore, no pharmaceutical intervention is typically needed. However, research consistently demonstrates pediatric nurses often medicate patients for such lowgrade fevers.
Project approach
Participants in an educational intervention to reduce inappropriate antipyretic use included 54 registered nurses employed in a major metropolitan pediatric emergency care center.
Pretesting evaluation was conducted prior to a didactic presentation on the pathophysiology, physiologic benefits, and common myths regarding fever. Immediate posttest results were evaluated. A 3-month follow-up survey will be administered to evaluate retained knowledge. Evaluation of antipyretic administration rates for a three month period after the education intervention will be compared to the same time period immediately before to evaluate reduction in use of antipyretics based on standardized procedures for fevers less than 38.5ºC (101.3ºF).
Outcomes
Analysis of the change between the pre- and posteducational intervention demonstrated only an 8% increase in knowledge among pediatric emergency nurses. Data regarding retention of knowledge and change in the use of antipyretics is pending.
Implications
Given the persistent lack of knowledge and tendency to over-treat lowgrade fevers in infants and children among the pediatric nurses in this setting, fever phobia may persist and continue to drain resources from an already overextended area of pediatric primary care. Presenting nurses with additional education to strengthen their knowledge of the physiologic benefits of fever and to dispel myths surrounding its dangers may help to bring about change in the culture of fever phobia.