Background NICE guidelines (2013) on fever recommend studies looking at home based use of antipyretics and parental perception of distress caused by fever. This study arose from observation of children presenting with fever, without correct usage of paracetamol and ibuprofen.

Method 1. Questionnaires were given to parents waiting to be seen in ED to determine parental understanding of giving ibuprofen and paracetamol, dosing intervals and with what symptoms they would give either medication. They were asked why they came to the ED and if they had tried to get an appointment with their GP.

2. A survey was undertaken of different brands of paracetamol and ibuprofen available over the counter. A new mother’s comments were gathered on the clarity of the instructions.

Results Results showed discrepancy between the number of times per day paracetamol and ibuprofen could be given: For paracetamol: 65%, 4 times/day, 21%, 6 times/day and 15%, 3 times/day. 46% of the sample was giving it incorrectly. Dosing intervals: 65%, 4 hourly, 26%, 6 hourly and 9%, 8 hourly. For ibuprofen: 41%, 3 times/day, 47%, 4 times/day, 12%, 6 times/day. Dosing intervals: 44%, 4 hourly, 35%, 6 hourly and 21%, 8 hourly. The survey identified discrepancy and lack of clarity of information, ’busyness’ of writing with variations including post immunisation dosing.

Conclusion There is concern parents are not given clear information as to dosage intervals and times per day that paracetamol and ibuprofen can be given and information available is often misinterpreted. The assumption may be 4 hourly means 6 times per day and with nonadherence to maximum doses. Education needs to take place regarding administration of analgesia and antipyretics, recognition of a sick child and when to seek medical help. We propose a quality improvement project developing standardisation of information on OTC products and an App giving parents clear information. This could allow input of age and dosing plus intervals for giving antipyretics and a traffic light system to determine when to seek medical help.