An evidence based proposal for change to improve the management of fever in children

Fever in children is the most common reason for parents to seek medical advice (Sullivan et al, 2011). Fever accounts for 20% of ED attendances with most feverish illnesses being the result of a self-limiting viral infection (Bonadio et al, 1993). The consensus amongst both health care professionals and parents is that fever is harmful (Wragg et al, 2014) despite evidence suggesting fever has a beneficial effect in fighting infection (Sullivan et al, 2011). The use of antipyretics for the sole purpose of reducing temperature is common practice amongst healthcare professionals while encouraging parents to do the same. Despite NICE guidelines stipulating that antipyretics should only be considered if the child appears distressed, antipyretics are routinely used for this purpose regardless if the child is otherwise well (NICE, 2013). Misconceptions surrounding fever and fever management is a result of the fear of febrile seizures and subsequent brain damage. These irrational fears have been described as ‘fever phobia’ and date back to the 1980’s (Schmitt, 1980) and remains the driving force for most research undertaken in this area. NICE (2013) guidelines offer best practice advice and recommendations on the care of children younger than 5 years with a feverish illness. Yet, their recommendations are not adhered to in everyday clinical practice. 5 key pieces of literature discussed in this dissertation highlights inconsistencies in practice and lack of knowledge regarding fever management. Healthcare professionals are in a prime place to offer knowledge and expertise to parents of children who present with fever (Crocetti et al, 2001), yet, if inconsistent practices which are not always based on the best available evidence remain they cannot educate parents on evidence-based fever management practices. This dissertation discusses an evidence based proposal for change with the aim of introducing existing guidelines into clinical practice. Incorporating Kotter’s change model (Kotter,1996) to structure the change management strategy with supporting theory provides an insight into the complexity involved in the change process