2.50
Hdl Handle:
http://hdl.handle.net/10755/157879
Type:
Presentation
Title:
Fever Management Following Head Injury: Practice Isn't Perfect
Abstract:
Fever Management Following Head Injury: Practice Isn't Perfect
Conference Sponsor:Western Institute of Nursing
Conference Year:2006
Author:Thompson, Hilaire, PhD, APRN, BC, CNRN
P.I. Institution Name:University of Washington
Title:Postdoctoral Fellow
Contact Address:School of Nursing, Box 357266, Seattle, WA, 98195-7266, USA
Contact Telephone:206-616-5641
Co-Authors:Catherine J. Kirkness, PhD, RN
Aims: 1) To determine the incidence of fever (Temperature > 38.5 degrees C) in a population of critically ill patients with traumatic brain injury (TBI). 2) To determine choices made by intensive care unit (ICU) nurses in managing fever. 3) To ascertain the rate of adherence with published normothermia guidelines. Background: Fever, in the presence of TBI, is associated with worsened neurologic outcomes. Studies prior to the publication of management guidelines revealed an undertreatment of fever in patients with neurologic insults (Albrecht et al., 1998; Kilpatrick et al., 2000). Initially published in 1996, adult TBI guidelines state that maintenance of normothermia should be a standard of care (Brain Trauma Foundation, 2000) therefore improvement in management of fever in these patients would be an expected outcome. As the primary decision maker regarding intervention for fever, the bedside nurse plays the critical role in this process, even when there is a protocol in place. Method: Medical record review of available hospital records was conducted on patients admitted over a two year period to a level I trauma center following severe TBI (N=108) from the parent study. Temperature data were abstracted and contemporaneous nursing documentation was examined for evidence of intervention for fever and adherence with published guidelines. Data analyses were performed that included descriptive statistics. Results: Seventy-nine percent of TBI patients (85/108) had at least one recorded fever event while in the ICU. However, in only 31% of events did the patient receive any documented intervention by nursing staff for the elevated temperature. The most frequently documented intervention was pharmacologic (358/1166 elevations). Other nursing actions (e.g., use of fan) accounted for a minority (<1%) of nursing interventions documented. Patients were more likely to have a high temperature that exceeded 40 degrees C (13%) than a temperature that was normothermic (5%). Implications: There continues to be an undertreatment of fever in patients with TBI by nurses despite our knowledge of its negative effects on outcomes. These findings reveal no improvement in practice over 10 years despite increased attention to this issue and publication of guidelines. There remains a gap in translation between patient outcomes research and bedside nursing practice that needs to be overcome. As bedside nurses make independent decisions in this regard, research efforts need to now focus on understanding their decision-making processes. This study was supported, in part, by NIH R01NR004901-05 and T32NR07106.
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Western Institute of Nursing

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleFever Management Following Head Injury: Practice Isn't Perfecten_GB
dc.identifier.urihttp://hdl.handle.net/10755/157879-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Fever Management Following Head Injury: Practice Isn't Perfect</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Western Institute of Nursing</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2006</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Thompson, Hilaire, PhD, APRN, BC, CNRN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">University of Washington</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Postdoctoral Fellow</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">School of Nursing, Box 357266, Seattle, WA, 98195-7266, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">206-616-5641</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">hilairet@u.washington.edu</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Catherine J. Kirkness, PhD, RN</td></tr><tr><td colspan="2" class="item-abstract">Aims: 1) To determine the incidence of fever (Temperature &gt; 38.5 degrees C) in a population of critically ill patients with traumatic brain injury (TBI). 2) To determine choices made by intensive care unit (ICU) nurses in managing fever. 3) To ascertain the rate of adherence with published normothermia guidelines. Background: Fever, in the presence of TBI, is associated with worsened neurologic outcomes. Studies prior to the publication of management guidelines revealed an undertreatment of fever in patients with neurologic insults (Albrecht et al., 1998; Kilpatrick et al., 2000). Initially published in 1996, adult TBI guidelines state that maintenance of normothermia should be a standard of care (Brain Trauma Foundation, 2000) therefore improvement in management of fever in these patients would be an expected outcome. As the primary decision maker regarding intervention for fever, the bedside nurse plays the critical role in this process, even when there is a protocol in place. Method: Medical record review of available hospital records was conducted on patients admitted over a two year period to a level I trauma center following severe TBI (N=108) from the parent study. Temperature data were abstracted and contemporaneous nursing documentation was examined for evidence of intervention for fever and adherence with published guidelines. Data analyses were performed that included descriptive statistics. Results: Seventy-nine percent of TBI patients (85/108) had at least one recorded fever event while in the ICU. However, in only 31% of events did the patient receive any documented intervention by nursing staff for the elevated temperature. The most frequently documented intervention was pharmacologic (358/1166 elevations). Other nursing actions (e.g., use of fan) accounted for a minority (&lt;1%) of nursing interventions documented. Patients were more likely to have a high temperature that exceeded 40 degrees C (13%) than a temperature that was normothermic (5%). Implications: There continues to be an undertreatment of fever in patients with TBI by nurses despite our knowledge of its negative effects on outcomes. These findings reveal no improvement in practice over 10 years despite increased attention to this issue and publication of guidelines. There remains a gap in translation between patient outcomes research and bedside nursing practice that needs to be overcome. As bedside nurses make independent decisions in this regard, research efforts need to now focus on understanding their decision-making processes. This study was supported, in part, by NIH R01NR004901-05 and T32NR07106.</td></tr></table>en_GB
dc.date.available2011-10-26T20:17:35Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T20:17:35Z-
dc.description.sponsorshipWestern Institute of Nursingen_GB
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