Australian College of Nursing
Recommendations from the Australian College of Nursing on peripheral IV catheters, blood glucose self-monitoring, antipyretics, urinary catheters & x-rays for ankle trauma. The Australian College of Nursing (ACN) is the national professional organisation for nurses in health and aged care settings. ACN provides nursing expertise to government and key stakeholders, and seeks to enhance the expertise of nurses when providing leadership and contribution to policy, practice and delivery of health care.
Don’t routinely administer antipyretics with the sole aim of reducing body temperature in un-distressed children.
Fever is defined as a rise in body temperature above the normal range of approximately 37.8 degrees Celsius and is commonly seen as a primary indication of illness in children. It is a normal physiological response to infection and illness and will not place a generally healthy child at harm.
The benefits of fever in slowing the growth and replication of bacteria and viruses are well documented within the literature, however the administration of pharmacological antipyretic therapy to reduce fever remains a common clinical intervention. Current evidence does not support the routine use of antipyretics solely to reduce body temperature but to maximise the comfort and well-being of the distressed child as an adjunct to the investigation and management of the cause of fever.
Antipyretic therapy is not effective in managing adverse symptoms of fever such as febrile convulsion. Supportive care that includes parental education is also important to increase understanding and to decrease anxiety.
- National Institute for Health and Clinical Excellence (NICE). Feverish Illness in Children – Assessment and Management in Children Younger than 5 years. NICE Clinical Guideline 47, 2013, London, UK.
- Carey, JV. Literature review: should antipyretic therapies routinely be administered to a patient fever? Journal of Clinical Nursing 2010; 19:2377-93.
- Greisman LA, Mackowiak PA. Fever: beneficial and detrimental effects of antipyretics. Current Opinion in Infectious Diseases 2002; 15(3):241-245.
- Sullivan JE, Farrar HC. Clinical report: Fever and antipyretic use in children. American Academy of Paediatrics 2011; 127(3).
- Van den Anker, J.N. Optimising the management of fever and pain in children. The International Journal of Clinical Practice 2013;67(Suppl.178).
The Australian College of Nursing (ACN) as nursing lead, established a collaborative working party incorporating a diverse range of nursing expertise. Professional nursing bodies involved in initial collaboration included: Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM); CRANAplus; Australian Primary Health Care Nurses Association (APNA); Australian College of Mental Health Nurses (ACMHN).
ACN’s membership was consulted via publications, web site and ACN’s National Nursing Forum. This consultation provided a broad view from our members regarding planning and delivery of nursing care across Australia. An interactive session invited delegates to actively participate in identifying those nursing practices, interventions, or tests that evidence shows provide no benefit or may even lead to harm. This informative stimulating session examined a range of nursing practices and their effects on healthcare consumers.
At this point specialist nursing groups were approached for comment on our recommendations. This group included: Australasian College for Infection Prevention and Control (ACIPC); Australian Diabetes Educators Association (ADEA); Continence Nurses Society Australia (CNSA); Australian and New Zealand Urological Nurses Society (ANZUNS); Medical Imaging Nurses Association (MINA); and the Australian and New Zealand Orthopaedic Nurses Association (ANZONA). Final consultation with ACN Members and Fellows prior to submission ensured a collaborative result.
- 1 Don’t replace peripheral intravenous catheter unless clinically indicated.
- 2 Don’t restrict the ability of people with diabetes to self-manage blood glucose monitoring unless there is a clinical indication to do so.
- 3 Don’t routinely administer antipyretics with the sole aim of reducing body temperature in un-distressed children.
- 4 Don’t use urinary catheters to manage urinary incontinence unless all other appropriate options have proved to be ineffective or to prevent wound infection or skin breakdown.
- 5 Don’t initiate plain X-ray for foot and ankle trauma unless criteria of the Ottawa Ankle Rules are met.