Fever Kits

We give starter packs of APAP but I've never seen a "kit" what would you have in it?

A couple of hospitals gave families little boxes with a digital thermometer, Tylenol and Motrin, and laminated dosage instructions. I'd like to include a couple of other things, too.

The subsequent studies showed that lost charges for what were essentially well baby visits, went down by 50-100 thousand dollars a year after providing this service.

Could you give a reference for those studies? I'm not doubting what you're saying at all, but I'd love to read that for myself, and to have that data for my own use.

"Fever phobia" and unnecessary clinic/ER visits are a pet peeve of mine so it's a subject I'm really interested in.

All I have is a couple of abstracts I found on the internet. I've got the hospital librarian doing a journal search, but she hasn't found much yet. When I read the articles I'll let you know.

One was from The Journal of Emergency Management and it was referenced in the NE edition of The Spectrum.

I want to find the ER that actually did the study and give them a call.

You must be dealing with a very different patient population than what I typically see ...

Triage Nurse: "Did you take your baby's temperature?"

Parent: "No, I brought him here."

Triage Nurse: "What did you try at home to bring the fever down?"

Parent: "What? I told you, I brought him here."

Primary/Discharging Nurse: "Your baby weighs x lbs., so that's x dose every 4-6 hours ..."

Parent: "You gonna give me a prescription for that? 'Cause I get that for free."

http://blog.oregonlive.com/washingtoncounty/2007/12/chill_out_parents.html

A Providence ER teaches how to keep a child's fever down, giving out simple kits to help The Emergency Department at Providence St. Vincent Medical Center in Cedar Mill is as predictable as the calendar: During cold winter nights and weekends, it is clogged with listless, feverish children and their exhausted parents.

While some children are ill enough to admit, staff send most with garden-variety ailments home, along with advice about keeping temperatures down.

But when fevers spike again, so do parents' fears. Families return a day or two later, the same sick child in tow.

The cycle can be draining -- and costly -- for everyone.

Last year, nurse Heidi Lindner and a group of colleagues worked to design pediatric "fever kits" after she read an article in a nursing publication about a Texas hospital that had used them.

FEVERISH?

In most children, normal body temperature is between 97.4 and 100.2 Fahrenheit (36.4 and 37.9 Celsius). Fevers can be brief, or come and go over a longer period. When a child has a fever, the body is telling the immune system to fight bacteria and viruses. Though fevers might help the body heal, treating one can help ease a child's discomfort.

The kits, which include a bottle of acetaminophen, a digital thermometer and a laminated dosing chart with instructions in English, Spanish, Russian and Vietnamese, reduced repeat hospital visits for fever.

In January, February and March, the hospital gave out 72 kits, said Marian Martin, nurse manager of the St. Vincent Emergency Department. Only three families returned.

In previous cold seasons, about half the patients had returned, Lindner said.

Martin said the kits, which are paid for with a small grant from Providence Health Plan, help empower parents.

"They may not have the experience or the resources to cope with a fever, or even buy the medicine," she said. "This does that."

And some parents are confused about how much medicine to give. "They'll say, 'I gave Tylenol this morning, but the fever is back.' They're afraid to overdo it, so they under-dose." The chart removes the guesswork, she said.

Indeed, a 2004 study in the journal of Pediatric Emergency Care showed that 12 percent of parents gave too much acetaminophen, while 41 percent gave too little. The authors concluded that proper dosing and timing could prevent most ER visits for fever.

The kits, which cost less than $3 to make, represented significant savings for the hospital, said Jean Marks, a St. Vincent spokeswoman.

"It gives tools to the parent and comfort to the child," she said. "And if the family doesn't have insurance, it helps us so we don't absorb the costs, either."

The idea for the kits originated in 2004 at the Presbyterian Hospital of Dallas, Texas, when nurse manager Mary Rowe wondered what the hospital could do to reduce "inappropriate return visits" for fever. The hospital defines such a visit as a return to the Emergency Department with upper respiratory infection or ear infection within 72 hours of initial treatment.

Many patients were inexperienced first-time parents or immigrant parents who lacked a support system, Rowe said.

"A lot of people are just here by themselves, without anyone who can tell them, 'This child is going to be OK,' " Rowe said.

"We certainly want them to come back if the child has a decrease in wet diapers (indicating dehydration), a seizure or is having trouble breathing," she said. "But a lot of folks were coming back when the child just had a minor fever or was fussy."

Within six months of launching the program, the hospital found an 80 percent drop in "inappropriate return visits" for fever. Between July and December 2004, Rowe said, the kits, which cost about $2.20 to make, saved the hospital about $55,000.

Locally, Providence is expanding its program to Providence Portland Medical Center, Marks said. "It's such a simple thing," she said, "and it can make such a big difference."

I too am looking into "fever kits" and am wondering if anyone has any experience with these in their ED? In doing a Google search I have found 3 hospitals that are using these but wonder if there are anymore??? If your ED provides these could you contact me with information. Thanks, diane

Our facility provides them without charge to parents (Nurses discretion). One bottle of tylenol/ibuprofen with a digitial thermometer. We also provide a weight specific dosing chart on the patients discharge instructions.

I don't know if you are still interested in this or not, but I work at Presby Dallas in the ED. This program has been great! Here is a link to the original article.

http://nursing.advanceweb.com/Editorial/Search/AViewer.aspx?AN=NW_06feb13_n8p14.html&AD=02-13-2006

Thanks E's mom. I have written to some of the ED's that I have found that have similar programs. Haven't gotten much feedback but what I have gotten is positive! Am currently working on a proposal to do a similar program in our ED. I did a short survey in triage with children that presented with fever as a complaint. Am going to do a longer one once cold and flu season hit us here.

You must be dealing with a very different patient population than what I typically see ...

Triage Nurse: "Did you take your baby's temperature?"

Parent: "No, I brought him here."

Triage Nurse: "What did you try at home to bring the fever down?"

Parent: "What? I told you, I brought him here."

Primary/Discharging Nurse: "Your baby weighs x lbs., so that's x dose every 4-6 hours ..."

Parent: "You gonna give me a prescription for that? 'Cause I get that for free."

Amen to that, i work in a Detroit ER where its common to have parents bring their 12mo. olds in for "diaper rash" and immediately want a snack pack.. UGH