Congress Abstracts 2006

136

ACCURATELY MEASURING TEMPERATURES IN CRITICALLY ILL ONCOLOGY PATIENTS. Mary Ellen Reese, RN, Tracy Douglas, RN, MSN, OCN^®, Karen Hauck, RN, BSN, Richard Mallik, RN, BSN, Mary Melvin, RN, Jill Roman, RN, BSN, Ellen Saltzman, RN, BSN, and Jennifer Fury, RN, BSN, Johns Hopkins Hospital, Baltimore, MD; and Julie Bauder, Johns Hopkins University School of Nursing, Baltimore, MD.

Temperature measurement in critically ill oncology patients is crucial for effective management. In the past, temperatures have been measured via axillary measurements. These measurements have been unreliable. Oral measurement of temperature is not routinely done in patients who are intubated or have an oxygen face mask. Many intensive care units use rectal thermometers to measure temperature. These are contraindicated in our setting. Using a urinary catheter temperature thermometer will prove to be a reliable and safe method of capturing a fever.

The purpose of this performance improvement project is to compare the use of urinary catheter thermometers with oral and axillary methods of measuring critically ill oncology patients' temperatures.

All patients requiring a urinary catheter and on oxygen greater than 60% will have a urinary catheter thermometer placed. A bladder, oral and axillary temperature measurement will be recorded every four hours. Bladder temperatures by the urinary catheter thermometer will be recorded continuously by physiological monitoring systems. The performance improvement project will continue until 1000 urinary catheter temperature measurements are taken or the measurement of 20 patients (which ever comes first). At least 250 measurements or five of the patients are to have a urine output >720ml in 24 hours (30ml/hr in 24 hrs.). The remaining measurements are to be done on patients who are oliguric or anuric. No patient will have more than two weeks worth of measurements. Each patient must have a temperature foley greater than or equal to 24 hours in order to be included in the study.

Temperature measurement greater than 38°C twice in 2 hours or greater than or equal to 38.3°C will be acted upon. The early capturing of a fever will enable the nurse to alert the physician to start fever management and antibiotic therapy as soon as possible.

Fever may be the first indication of infection in a patient with a suppressed immune system. Urinary catheter thermometers will allow the temperature to be monitored continuously in the neutropenic and thrombocytopenic patient.