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Guideline Summary
Guideline Title
Best evidence statement (BESt). Axillary temperature taking tools: the evidence for change.
Bibliographic Source(s)
Cincinnati Children's Hospital Medical Center. Best evidence statement (BESt). Axillary temperature taking tools: the evidence for change. Cincinnati (OH): Cincinnati Children's Hospital Medical Center; 2011 Apr 18. 4 p. [6 references]
Guideline Status

This is the current release of the guideline.

Scope

Disease/Condition(s)
  • Any condition which may cause a change in body temperature
  • Fever or suspicion of fever
Guideline Category
Technology Assessment
Clinical Specialty
Family Practice
Internal Medicine
Pediatrics
Intended Users
Advanced Practice Nurses
Nurses
Physician Assistants
Physicians
Guideline Objective(s)

To evaluate among pediatric patients ages 2 months to 21 years if taking their axillary temperature using a chemical dot thermometer versus an electronic thermometer improves the accuracy and efficiency of the temperature taken, decrease cost, and maintain infection control standards

Target Population

Children 2 months to 21 years of age

Interventions and Practices Considered

Chemical dot thermometer versus an electronic thermometer

Major Outcomes Considered
  • Accuracy and efficiency of the temperature taken
  • Cost
  • Infection control standards

Methodology

Methods Used to Collect/Select the Evidence
Searches of Electronic Databases
Description of Methods Used to Collect/Select the Evidence

Search Strategy

  • Databases used: Medline, CINAHL, Cochrane databases
  • Key words used: Pediatric, temperature, axillary, chemical dot, electronic, digital
  • Filters/limits: English language
  • Date range searched: all through August 1, 2010
Number of Source Documents

Not stated

Methods Used to Assess the Quality and Strength of the Evidence
Weighting According to a Rating Scheme (Scheme Given)
Rating Scheme for the Strength of the Evidence

Table of Evidence Levels

Quality Level Definition
1a† or 1b† Systematic review, meta-analysis, or meta-synthesis of multiple studies
2a or 2b Best study design for domain
3a or 3b Fair study design for domain
4a or 4b Weak study design for domain
5 Other: General review, expert opinion, case report, consensus report, or guideline

†a = good quality study; b = lesser quality study

Methods Used to Analyze the Evidence
Systematic Review
Description of the Methods Used to Analyze the Evidence

Not stated

Methods Used to Formulate the Recommendations
Expert Consensus
Description of Methods Used to Formulate the Recommendations

Not stated

Rating Scheme for the Strength of the Recommendations

Table of Recommendation Strength

Strength Definition
"Strongly recommended" There is consensus that benefits clearly outweigh risks and burdens (or visa-versa for negative recommendations).
"Recommended" There is consensus that benefits are closely balanced with risks and burdens.
No recommendation made There is lack of consensus to direct development of a recommendation.
Dimensions: In determining the strength of a recommendation, the development group makes a considered judgment in a consensus process that incorporates critically appraised evidence, clinical experience, and other dimensions as listed below.
  1. Grade of the Body of Evidence (see note above)
  2. Safety/Harm
  3. Health benefit to patient (direct benefit)
  4. Burden to patient of adherence to recommendation (cost, hassle, discomfort, pain, motivation, ability to adhere, time)
  5. Cost-effectiveness to healthcare system (balance of cost/savings of resources, staff time, and supplies based on published studies or onsite analysis)
  6. Directness (the extent to which the body of evidence directly answers the clinical question [population/problem, intervention, comparison, outcome])
  7. Impact on morbidity/mortality or quality of life
Cost Analysis

Local cost of purchasing chemical dot thermometers is less than the cost of purchasing, maintaining, and providing probe covers for the electronic thermometer.

Method of Guideline Validation
Peer Review
Description of Method of Guideline Validation

Reviewed against quality criteria by two independent reviewers

Recommendations

Major Recommendations

The strength of the recommendation (strongly recommended, recommended, or no recommendation) and the quality of evidence (1a-5) are defined at the end of the "Major Recommendations" field.

It is recommended that the chemical dot thermometer be used to measure axillary temperature among pediatric patients over the age of 2 months (Barton et al., 2003 [4a]; El Radhi & Patel, 2007 [4b]; Khorshid et al., 2005 [4a]; Van den Bruel et al., 2005 [4a]; local data [5]).

Note 1: The chemical dot axillary temperature measurements were statistically as equally accurate as the electronic temperature measurements with an average difference (bias) of 0.76° F (95% limits of agreement 2.35 and -0.84) (Barton et al., 2003 [4a]).

Note 2: Local cost of purchasing chemical dot thermometers is less than the cost of purchasing, maintaining and providing probe covers for the electronic thermometer (local data [5]).

Note 3: The disposable nature of the chemical dot thermometer may prevent the spread of infection among patients (Barton et al., 2003 [4a]).

Definitions:

Table of Evidence Levels

Quality Level Definition
1a† or 1b† Systematic review, meta-analysis, or meta-synthesis of multiple studies
2a or 2b Best study design for domain
3a or 3b Fair study design for domain
4a or 4b Weak study design for domain
5 Other: General review, expert opinion, case report, consensus report, or guideline

†a = good quality study; b = lesser quality study

Table of Recommendation Strength

Strength Definition
"Strongly recommended" There is consensus that benefits clearly outweigh risks and burdens (or visa-versa for negative recommendations).
"Recommended" There is consensus that benefits are closely balanced with risks and burdens.
No recommendation made There is lack of consensus to direct development of a recommendation.
Dimensions: In determining the strength of a recommendation, the development group makes a considered judgment in a consensus process that incorporates critically appraised evidence, clinical experience, and other dimensions as listed below.
  1. Grade of the Body of Evidence (see note above)
  2. Safety/Harm
  3. Health benefit to patient (direct benefit)
  4. Burden to patient of adherence to recommendation (cost, hassle, discomfort, pain, motivation, ability to adhere, time)
  5. Cost-effectiveness to healthcare system (balance of cost/savings of resources, staff time, and supplies based on published studies or onsite analysis)
  6. Directness (the extent to which the body of evidence directly answers the clinical question [population/problem, intervention, comparison, outcome])
  7. Impact on morbidity/mortality or quality of life
Clinical Algorithm(s)

None provided

Evidence Supporting the Recommendations

References Supporting the Recommendations
Type of Evidence Supporting the Recommendations

The type of supporting evidence is identified and graded for each recommendation (see the "Major Recommendations" field).

Benefits/Harms of Implementing the Guideline Recommendations

Potential Benefits
  • Improved accuracy and efficiency of the temperature taken
  • Decreased cost
  • Maintenance of infection control standards
Potential Harms
  • Falsely high or low temperature readings could result in unnecessary diagnostic procedures and treatment and/or missed diagnosis.
  • Use of medical equipment, without proper cleaning between patients, may increase risk of cross-contamination.

Qualifying Statements

Qualifying Statements
  • This Best Evidence Statement addresses only key points of care for the target population; it is not intended to be a comprehensive practice guideline. These recommendations result from review of literature and practices current at the time of their formulation. This Best Evidence Statement does not preclude using care modalities proven efficacious in studies published subsequent to the current revision of this document. This document is not intended to impose standards of care preventing selective variances from the recommendations to meet the specific and unique requirements of individual patients. Adherence to this Statement is voluntary. The clinician in light of the individual circumstances presented by the patient must make the ultimate judgment regarding the priority of any specific procedure.
  • It was noted that some nursing staff did not understand the correct techniques for the available equipment to obtain the most accurate temperature on each patient. Inconsistent practice across nursing units decreased the accuracy of axillary temperatures.

Implementation of the Guideline

Description of Implementation Strategy

An implementation strategy was not provided.

Institute of Medicine (IOM) National Healthcare Quality Report Categories

IOM Care Need
Staying Healthy
IOM Domain
Effectiveness

Identifying Information and Availability

Bibliographic Source(s)
Cincinnati Children's Hospital Medical Center. Best evidence statement (BESt). Axillary temperature taking tools: the evidence for change. Cincinnati (OH): Cincinnati Children's Hospital Medical Center; 2011 Apr 18. 4 p. [6 references]
Adaptation

Not applicable: The guideline was not adapted from another source.

Date Released
2011 Apr 18
Guideline Developer(s)
Cincinnati Children's Hospital Medical Center - Hospital/Medical Center
Source(s) of Funding

Cincinnati Children's Hospital Medical Center

Guideline Committee

Not stated

Composition of Group That Authored the Guideline

Group/Team Leader: Amy Hall-Haering, DNP(c), RN, CPN, A6N/A7C, Patient Services

Other Group/Team Members: Gigi Honn, BSN, RNII, CPN, Neighborhood Locations; Jennifer Willoughby, BSN, RN, CPN, Care Manager, Division of Pediatric Gastroenterology, Hepatology and Nutrition; Lorna Frank, MSN, RN, BC, Education Consultant, Center for Professional Excellence/Education; Lisa Devoto, BSN, RN, CPN, RRT, AE-C, Asthma Coordinator, Division of Respiratory Care

Support Personnel: Barbara Giambra MS, RN, CPNP, Evidence-Based Practice Mentor, Center for Professional Excellence/Research and Evidence-Based Practice

Financial Disclosures/Conflicts of Interest

The authors do not have any conflict of interest to report.

Guideline Status

This is the current release of the guideline.

Guideline Availability

Electronic copies: Available from the Cincinnati Children's Hospital Medical Center External Web Site Policy.

Print copies: For information regarding the full-text guideline, print copies, or evidence-based practice support services contact the Cincinnati Children's Hospital Medical Center Health James M. Anderson Center for Health Systems Excellence at EBDMInfo@cchmc.org.

Availability of Companion Documents

The following are available:

Print copies: For information regarding the full-text guideline, print copies, or evidence-based practice support services contact the Cincinnati Children's Hospital Medical Center Health James M. Anderson Center for Health Systems Excellence at EBDMInfo@cchmc.org.

Patient Resources

None available

NGC Status

This NGC summary was completed by ECRI Institute on September 22, 2011.

Copyright Statement

This NGC summary is based on the original full-text guideline, which is subject to the following copyright restrictions:

Copies of this Cincinnati Children's Hospital Medical Center (CCHMC) External Web Site Policy Best Evidence Statement (BESt) are available online and may be distributed by any organization for the global purpose of improving child health outcomes. Examples of approved uses of the BESt include the following:

  • Copies may be provided to anyone involved in the organization's process for developing and implementing evidence based care
  • Hyperlinks to the CCHMC website may be placed on the organization's website
  • The BESt may be adopted or adapted for use within the organization, provided that CCHMC receives appropriate attribution on all written or electronic documents; and
  • Copies may be provided to patients and the clinicians who manage their care

Notification of CCHMC at EBDMInfo@cchmc.org for any BESt adopted, adapted, implemented or hyperlinked by the organization is appreciated.

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