Proposed Topic (Most preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Authors (including presenting author) :
Ho KW(1), Fok KY(1), Yeung CW(1), Yun KY(1), Au WK(1), Tsui MH(1)
Affiliation :
(1)Department of Neurosurgery, Princess Margaret Hospital
Introduction :
Patients with acute brain injury (ABI) including traumatic brain injury (TBI) and subarachnoid hemorrhage (SAH) are vulnerable to hyperthermia. Hyperthermia has negative effects on brain metabolism and cerebral blood flow (CBF). On the other hand, hyperthermia is commonly observed because of the direct injury to hypothalamus in the cases of patients with TBI (Goyal et al., 2020). The injured brain is sensitive to body temperature changes. If the compensatory mechanisms are exhausted, the intracranial pressure (ICP) is increased due to the high cerebral blood volume. The above negative outcomes can lead to increase length of stay, lower Glasgow Outcome Scores (GCS) or higher mortality rates. It is essential to perform febrile management in order to be a competent nurse working in neurosurgery department. However, there is a variation on practice among nursing staff to handle patients with fever. To overcome, a fever management protocol was rolled out in neurosurgery department started from May to July 2023.
Objectives :
It is aimed to standardize nursing care practice on fever management for patient with acute brain injury in high dependency unit of neurosurgery. Through the project, fever management protocol is developed with evidence based support, recommendations regarding fever and persistent fever are proposed. Also to enhance nurse’s knowledge and clinical practice on fever management, promote the standardized fever management protocol and evaluate the compliance rate of the fever management protocol were the objectives.
Methodology :
Literature review was done for the set up of fever management protocol. Three identical training sessions were arranged and 33 staffs attended the training. The protocol was divided into three stages. For low grade fever (temperature >=37.5-37.9°C), ice pack gel is suggested. For hyperthermia (temperature >=38°C), inform doctor to prescribe antipyretic drug. For persistent fever (fever for 3days) or high fever (temperature >=38.5°C for 2days), a cooling blanket is suggested to apply at least 5 days unless hypothermia developed.
Result & Outcome :
Nurses got only 42% mean score in 8 MCQs pre-test questionnaire and increase to 80% mean score in post-test questionnaire. The knowledge on fever management among nurses were improved. Especially for the knowledge of applying a cooling blanket. Only 26% correct rate before training but it increased to 84% after training. Total of 26 fever cases were reviewed throughout the implementation period. The compliance rate on applying ice pack is 100%. Medication prescription rate was 92% by reviewing IPMOE records. However, the compliance rate of applying a cooling blanket was low. There were 5 cases need to apply a cooling blanket but only 3 cases were applied due to limited cooling machine in our department.
