6032 Audit of the management of fever in children under 5 at princess Alexandra hospital

Objectives The National Institute for Health and Care Excellence (NICE) quality statements suggests that children under 5 years of age with an unexplained fever (above 38 degrees celsius) should have their risk of serious illness assessed and recorded using a traffic light system, where green is low risk, amber is medium risk, and red is high risk.1 The aims of this quality improvement project were to determine if the guidelines for the management of children under 5 years of age with an unexplained fever presenting to our local Paediatric Emergency Department (ED) have been adhered to. We also developed a flow-chart tool outlining how to approach each risk stratification to help clinicians manage these children. Methods We retrospectively collected data using a data collection tool for all children under 5 years of age who presented to our local ED with a fever in October 2021 and January 2022. This data collection tool allowed us to record clinical factors such as their early warning score, that were used to risk stratify patients. The care they received was subsequently analysed to see whether they were managed appropriately. All the data was compiled and analysed using Microsoft Excel. Regular training sessions were then undertaken for paediatric and ED clinicians. A flow chart outlining the management for children with a fever depending on their risk stratification was designed as a tool to help clinicians. A leaflet for parents was also made, outlining 'red flag' signs and symptoms that would warrant urgent medical attention. Results 138 cases were identified for analysis. 86% of patients received appropriate treatment for their risk stratification according to NICE recommendations. A majority of patients (57.2%) fell into the amber risk category. Amongst the 14% whose management was not complaint with NICE guidelines, 4 patients did not receive any safety net advice, 5 had no documentation of the treatment they received, 4 did not have a period of observation where it was warranted, and 7 patients had a lack of investigations. This resulted from: blood tests, urine dips, or chest X-rays which were required and should have been performed. Conclusion Compliance with NICE recommendations for the management of fever in children under the age of 5 was high at our local paediatric emergency department. However, failure to adhere to these recommendations may result in serious harm. We hope that with the addition of our management tool and regular teaching, we can improve compliance to ensure safe practice. We aim to re-audit our intervention in due course. Reference Overview: Fever in under 5S: Assessment and initial management: Guidance (no date) NICE. Available at: https://www.nice.org.uk/guidance/ng143 (Accessed: 27 October 2023).