Current evidence shows that fever and hyperthermia are especially detrimental to patients with neurologic injury, leading to higher rates of mortality, greater disability, and longer lengths of stay. Although clinical practice guidelines exist for ischemic stroke, subarachnoid hemorrhage, and traumatic brain injury, they lack specificity in their recommendations for fever management, making it difficult to formulate appropriate protocols for care. Using survey methods, the aims of this study were to (a) describe how nursing practices for fever management in this population have changed over the last several years, (b) assess if institutional protocols and nursing judgment follow published national guidelines for fever management in neuroscience patients, and (c) explore whether nurse or institutional characteristics influence decision making. Compared with the previous survey administered in 2007, there was a small increase (8%) in respondents reporting having an institutional fever protocol specific to neurologic patients. Temperatures to initiate treatment either based on protocols or nurse determination did not change from the previous survey. However, nurses with specialty certification and/or working in settings with institutional awards (e.g., Magnet status or Stroke Center Designation) initiated therapy at a lower temperature. Oral acetaminophen continues to be the primary choice for fever management, followed by ice packs and fans. This study encourages the development of a stepwise approach to neuro-specific protocols for fever management. Furthermore, it shows the continuing need to promote further education and specialty training among nurses and encourage collaboration with physicians to establish best practices.
Hannah Rockett, MN ARNP CNRN, was an Adult-Gerontology Nurse Practitioner Student, University of Washington School of Nursing at the time of acceptance. She is now a Nurse Practitioner in the Regional Epilepsy Center at Harborview Medical Center, Seattle, WA.
Questions or comments about this article may be directed to Hilaire J. Thompson, PhD RN CNRN ACNP-BC FAAN, at firstname.lastname@example.org. She is an Associate Professor, Biobehavioral Nursing and Health Systems, University of Washington School of Nursing, Seattle, WA.
Patricia A. Blissitt, RN PhD CCRN CNRN CCNS CCM ACNS-BC, is a Clinical Associate Professor, Biobehavioral Nursing Health Systems, University of Washington School of Nursing, and Neuroscience Clinical Nurse Specialist, Harborview Medical Center and Swedish Medical Center, Seattle, WA.
The authors declare no conflicts of interest.
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