Poster - #2022UCDH-38 - Keywords: pediatric picu fever evidence-based

Pediatric Fever: An Evidence-Based Implementation Project

Jennifer Ramey, MS, RN, CCRN Dawn Harbour, RN, MSN, CNS, AACNS-P, CCRN
California State University Dominguez Hills School of Nursing Sutter Medical Center Sacramento University of California Davis Health

ABSTRACT:
Background: Nurses are responsible for fever management. Pediatric intensive care unit (PICU) nurses are not following evidence-based practices (EBP) when treating fever, but instead are relying on anecdotal experiences. Purpose: The purpose of this EBP project was to increase nurses’ knowledge of EBP fever management and to influence nurses to update their practice based on this new knowledge. Methods: Guided by the Knowledge-to-Action (KTA) translational model, this EBP project was implemented in two PICUs in Northern California (at a community and a university hospital). EBP fever management was identified through a review of the literature. The PICU nurses completed a pre-survey assessing their knowledge and practices on fever. Surveys were provided in paper and electronic (URL or QR code) formats. A gap-analysis of the pre-survey results revealed key educational opportunities: EBP febrile interventions, fever vs. hyperthermia, metabolic demand, and febrile seizures. Educating during the COVID-19 pandemic proved to be very challenging and required flexibility and adaptation on the fly. A 2-page educational flyer was created as the educational intervention, in lieu of a class or online module, due to the pandemic. The flyer was designed to be detailed enough to establish a strong foundation of knowledge but brief enough to appeal to a burned-out audience. The flyer was distributed to all nurses via e-mail and nurses were in-serviced at the bedside over a 2-week period. A post-survey assessed nurses’ increase in knowledge and their willingness to update their practice after the educational intervention. Results: Compared to the pre-survey, the post-survey showed an increase in nurses’ knowledge by respondents correctly identifing: “comfort” as the goal of fever management (17% vs. 84%); febrile seizure as non-preventable (14% vs. 95%); and appropriate uses of physical cooling (10% vs. 100%). The post-survey also revealed that nurses were willing to update their practice based on their new knowledge. 100% of nurses “strongly agreed” or “agreed” with the statement ‘I plan to update my practice based on the evidence presented in the educational flyer’ and 85% of nurses “strongly agreed” or “agreed” with the statement ‘I feel comfortable teaching families about evidence-based fever management.’ Conclusion: Increasing knowledge of EBP through an educational flyer and in-servicing does influence willingness of PICU nurses to update their practice in managing pediatric fever. A secondary finding, using multiple survey formats increases response rate from nurses. Next steps would be an audit 6-12 months after education to assess if nurses did in fact change their practice, extending training to all pediatric units, and including the education in new employee orientation. Further study is needed in pediatric fever, especially the metabolic impact of fever and physical cooling.