Context This project was performed in a primary setting general practice surgery between October 2013 and January 2014. It involved analysis of data submitted by staff at the surgery including foundation doctors, registrar trainees, general practitioners and nurses.
Problem The aim of the project was to analyse the assessment and management of the febrile child under five years in a primary setting. This topic was chosen as infections was the main reason for children under five presenting to a general practice setting as well as being the leading cause of death. The National Institute for Health and Care Excellence (NICE) fever pathway was updated in May 2013 which provided a good framework for managing these cases and adherence to the fever pathway was assessed.
Assessment of problem and analysis of its causes According to the NICE fever pathway all children presenting with a fever should have their temperature, hear rate, respiratory rate and capillary refill time measured and recorded. Data was collected on the Egton Medical Information System (EMIS) retrospectively between May 2013 and August 2013 to determine whether this standard was adhered to. The results showed that only 10% of patients presenting with a fever has all parameters recorded.
Intervention In order to improve the documentation and assessment of the febrile child this data was presented to members of the practice in a team meeting highlighting the importance of measuring all the parameters in assessment of a child with a fever. A template was also designed to make this documentation more effective and presented to staff at the meeting. This template was added to EMIS and would be highlighted once the terms fever or temperature is documented on EMIS for any child under the age of 5.
Study design The project was designed as an audit using the NICE fever pathway as the standard.
Strategy for change A teaching session was set up including all practice members. The data was presented as well as the recently improved NICE guidelines and traffic light system. Feedback from staff members on ways to improve data recording was encouraged through an informal discussion. The febrile child template was also presented to staff members showing them how it will be accessed and explaining how it should be used with reference to the NICE standards.
Measurement of improvement The impact of the intervention was determined by reassessing the data on EMIS after installing the febrile child template. Information entered on EMIS between November 2013 to January 2014 for each child presenting with a fever was analysed to determine if the assessment adhered to NICE standards.
Effects of changes The re-audit showed that following the teaching session on the assessment of the febrile child and the implementation of a template for recording the data there was a statistically significant improvement in assessing the febrile child with 62% having all parameters recorded in comparison to 10% on initial audit. This showed an improvement in management of these cases through accurate referrals to secondary care as well as appropriate use of antibiotics and safety net thus showing an overall improvement in clinical care.
Lessons learnt This project highlighted that simple interventions such as teaching sessions and the use of templates for recording data can improve clinical care of patients.
Message for others In busy clinical settings proformas and templates are helpful ways to standardise assessments and management of patients to ensure excellent standards of clinical care.
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