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Inaccurate body temperature measurements impact clinical decision-making and patient safety. Nurses in our large free-standing children's hospital and clinics questioned the accuracy of certain thermometer devices. Our clinical practice policy on temperatures allowed nurses to use their clinical judgment about which device and route of thermometry should be used for their patients. An audit of our hospital and clinic thermometer purchases from January to May 2014 revealed seven different devices. The purpose of this evidence-based practice (EBP) project was to select the most precise and accurate temperature-taking routes and measurement methods to set as the standard for our hospital system. The evidence-based project began with the intent to conduct a systematic review of the literature on the accuracy of non-core thermometer devices. While developing evidence tables, it became clear that the results and conclusions of the studies were so inconsistent that we could not select the most accurate thermometer devices for our hospital system. We realized only studies comparing core vs. non-core were appropriate, and a meta-analysis was required to summarize data from core vs. non-core temperatures. Evidence shows that oral and rectal electronic thermometers provided the most accurate approximation of core body temperatures. Our findings resulted in a revision of the temperature policy. One year after the policy change, unit-by-unit observations of devices showed significant usage of approved devices. This successful practice and policy change improved clinical decision-making based on more accurate and consistent body temperatures.
Rapid improvements in the technology of measuring body temperature and the search for more non-invasive methods have resulted in numerous devices designed for pediatric patients. In our 464-bed, free-standing children's hospital system, purchasing decisions are made independently by departments. We found that seven different thermometer devices were used in the ambulatory and hospital settings. These devices included electronic temporal artery, tympanic, oral, axillary, and rectal thermometers, and chemical oral and axillary thermometers. For economic and clinical safety reasons, purchasing decisions should be based on evidence that thermometer devices provide the most precise and accurate temperature readings. Thermometer manufacturers test measurement precision in laboratory settings. Despite manufacturers' claims, research continues to show the precision and accuracy of temperature measurement devices differ widely. Our ambulatory care nurses' spirit of inquiry prompted questions about why different types of thermometers were...