Thursday, January 03, 2008


Welcome to Vickie’s Research Corner. I hope everyone had a wonderful holiday season. Well, here we are in 2008 and we are back to evidence-based practice (EBP) and research projects. This year should be really interesting so watch out for all the new projects coming your way.
For the first project of the year, I would like to introduce you to Amy Waunch. She is the Advanced Practice Nurse (APN) in the Emergency Department.

What is the name of your project?
Emergency Department Pediatric Temperature Study

What is your study about?
The purpose of my study is to compare temporal artery thermometer readings in emergency department patients 17 years and younger with oral, rectal, and axillary temperatures. A study sub-aim is in patients who have received antipyretics, to evaluate the presence of a “lag” in any measure compared to others due to physiologic responses to the antipyretic.

Is it EBP/Research study?
Research- a correlational comparative study.

What made you interested in this project?
Fever is the most common complaint of children seen in a pediatric emergency department (Poiriert et al. 2000). Temperature measurements reflect changes in physiologic status that may require clinical interventions. Accuracy of temperature readings and an understanding of different routes of temperature taking can affect health providers decisions concerning critically ill children and infants. In a busy ED, taking temperatures can be problematic and we were looking at the best method for taking temperatures in children.
A new thermometer, for temporal artery readings has been developed. The temporal thermometer (Exergen Corp., Walterton MA) computes temporal artery temperature by using a heat balance method. This method is noninvasive and more comfortable than rectal temperatures in infants. A representative from the company approached our ED about using this thermometer stating their studies demonstrated this is more or at least as accurate as rectal thermometry.
After looking into the research, I realized there has been no study found comparing temporal artery readings with oral, rectal, and axillary readings among children 17 years or younger admitted to emergency departments. I wanted to insure using the best method possible in our ED instead of taking a sales representatives word. I wanted to actually have research versus opinion. Therefore, I created a study.

How did you go about your research?
I started with a literature review and couldn’t find a clear-cut conclusion on the accuracy of temporal artery thermometry use on pediatric patients presenting to an emergency department. I then investigated the community standard of care for pediatric temperature attainment and learned that practice varies greatly form one hospital to another. I looked to expert opinion from professional organizations such as the American Association of Pediatrics and the American College of Emergency Physicians, again with no consensus.
So I decided to talk to Dana Rutledge to help me do a more extensive literature search. We found there is no gold standard or clear evidence for taking temperatures in pediatric patients. At this point we decided to create a research study. For the study I asked Beth Winokur, the Clinical Educator for the ED, and John Senteno, the Director of ED to help. Dana wrote the proposal and gave input. I formulated a team of interested persons: Christine Marshall, Clinical Nurse IV in the ED; Mike Vicioso, Pediatric Manager in ED; and Beth Winokur. We then applied for the IRB. For the last year we have been trying to accrue patients for the study.

What are your expected outcomes?
I believe we may find that the temporal artery thermometer is inconsistent. I also think we may find that axillary temperatures are inconsistent as well. Data from research states that rectal temperatures are the closest to the core temperature but unfortunately they are the most invasive. I hope to find that the temporal artery thermometer is a reliable and accurate means of obtaining temperatures in pediatric patients in the ED. This method is non-invasive and will cause less anxiety among parents compared to rectal thermometry.

Have you done research before? If so what did you learn?
I have co-investigated randomized clinical trials for asthma when I worked at an allergy office as a Nurse Practitioner. I learned that acquiring data is very detailed oriented. I also learned that the IRB is really designed to keep the best interest of the patients. I actually was pleasantly surprised going through the IRB that our study was approved for an expedited review due to the fact we worked with a vulnerable population.
Research can be very challenging, especially this study! We have had problems with data collection due to time of the RNs acquiring patients, making sure all the coinvestigators were compliant with the CITI training that CHOC’s IRB makes you complete prior to research, and the challenges of the administrative end of paperwork.

Will you do research/project again?
Yes, but next time I will get more help from the beginning and more people involved who are dedicated to the time issue.

Poirier, M.P., Davis. P.H., Gonzalez-del Ray, J.A., & Monroe, K.W. (2000). Pediatric emergency department nurses’ perspectives on fever in children [Abstract]. Pediatric Emergency Care, 16, 9-12.

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