1. Audit of the assessment of the feverish child in
[i] Fever in under 5’s; assessment and initial management. NICE Guidelines (CG160)
We plan to offer the template to all practices in the Airedale training scheme to help improve assessment of fever in children under five years and subsequently re-audit across participating practices.
We included all children under five years seen in a two week period with a history of fever (n=14). We assessed the documentation of colour, activity, signs of respiratory compromise , hydration status and temperature.
[i] Fever in under 5’s; assessment and initial management. NICE Guidelines (CG160)
Audit of the assessment of the feverish child in
primary care: a template for system one
Molyneux L, Worthington S, McEnery R.
Kilmeny Group Medical Practice, West Yorkshire, UK
Background
Infections are the main cause of death in children under five  years and fever is one of the most common reasons for children to be brought to primary care.
Assessment of children under five years with fever can be challenging for clinicians in primary care.
Recent guidelines from the National Institute for Clinical Excellence (NICE) provide a clear framework for the assessment of children under five years in primary care using a traffic light system[i].
Aim
To assess the documentation of the assessment of the feverish child in an urban practice in West Yorkshire using the NICE guidelines
Methods
A retrospective audit of system one records over a two week period during November 2014.
We included all children under five years seen in a two week period with a history of fever (n=14).
We assessed the documentation of colour, activity, signs of respiratory compromise , hydration status and temperature.
Results
Documentation was incomplete
for all records with a variety of
vital parameters omitted,
notably assessment of
respiratory compromise was
included in just 32% of records
We designed a system one template using the NICE framework to improve documentation and act as an aid memoir for paediatric physiological parameters.
A re-audit two months after
implementation showed an
improvement in the
documentation of all parameters,
in particular markers of
respiratory compromise .
Documentation of parameters %
Documentation of parameters reaudit
Discussion
We have been able to demonstrate an improvement in documentation following the introduction of the system one template.
We plan to offer the template to all practices in the Airedale training scheme to help improve assessment of fever in children under five.
References
 Fever in under 5’s; assessment and initial management. NICE Guidelines (CG160)
Contributions
Dr C Small. Queen Elizabeth Hospital, Birmingham, UK