Study finds there is no national standard of practice


Article Content

More than 70% of patients who've suffered traumatic brain injury and more than 38% who've had a stroke develop fever, which is associated with higher death rates. Guidelines for treating patients with neurologic insults state that normothermia should be maintained, but none define what that is or how to achieve it. Researchers from the University of Washington School of Nursing in Seattle surveyed members of the American Association of Neuroscience Nurses to determine whether institutions have fever management protocols, what those entail, and whether they vary by geographic region.


Of 328 respondents, only 19% reported that their neuroscience unit had a fever management protocol specifically for patients with neurologic injuries. In addition, the temperature at which treatment was initiated ranged from 37[degrees]C (98.6[degrees]F) to 40[degrees]C (104[degrees]F), with nurses from the Midwest tending to report a higher threshold at which treatment to lower the temperature was initiated. All neurology-specific fever protocols called for administering acetaminophen, while other common interventions included water cooling blankets and ice packs. Nurses in the Midwest were more likely than those in other regions to add ibuprofen, while those in the West were more likely to use circulating fans, a controversial practice that some institutions have banned as having the potential to spread infection (despite the absence of studies evaluating that possibility). Some nurses felt that at their institution, fever often was not treated aggressively enough.


Among the institutions reported to have fever management protocols, the most commonly used intervention was acetaminophen 650 mg every four hours. Also prevalent were the use of ice packs, water-cooling blankets, and tepid bathing. The study also showed that bedside nurses are often the primary decision maker on fever management interventions.


Primary author Hilaire Thompson told AJN, "Despite the fact that we've had published guidelines addressing the need to maintain normothermia in our patients since 1996, it's concerning to note that fewer than 20% of respondents had temperature management protocols in place. Additionally, the wide variation in the temperature at which treatment was initiated is of concern," given that guidelines stipulate initiate treatment at 37.5[degrees]C (99.5[degrees]F) or 38[degrees]C (100.4[degrees]F). She added that nurses caring for patients with neurologic insults need to review their institution's current policy and procedures and work collaboratively with their colleagues to develop interdisciplinary patient care protocols for temperature management.


Thompson HJ, et al. J Neurosci Nurs 2007;39(3):151-62.