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Oncology Population for Temperature MeaurEquivalence of Temperature Measurement Methodsement Methods and Patient Education on Monitoring Temperature
1.What was the knowledge gained from the article?
2.Will the research/information in this article change or influence your practice? If so how?
3.What other questions does the article raise about current practice?
4.Do you agree/disagree with the conclusions of the author, why?Hi, I’m Sherry Khabiri and I work in the ICC.
1) These articles reinforced to me that there is a need for teaching in our patient population. We see patients every day that are at high risk for infection and may not have a good understanding of how to monitor for this. The articles showed that we need to assess our patients on their level of understanding and reinforce this teaching with them at their visits. We need to make sure they have a thermometer at home and have knowledge of how to use and read it.
2) Yes, This article will influence my practice. I will be make sure I review with my patients temperature guidelines, other signs of infection, things that cause false temperature readings and their access to a thermometer. I feel the fever question in the toxicity screening is a great opportunity to do this. I will also provide patient education handouts when needed and I will obtain a thermometer for my patients if they need one.
3) This article raises some questions about the method of non-invasive temperature methods we use at OSU. This article showed that axillary temps are less accurate but it is a method we use ofter. It also shows us that we need to do more teaching and reinforcement with our patients.
4) The article “Equivalence of temperature methods in the adult Hem/Onc population” concluded that the temperal artery thermometer is an acceptable non-invasive alternative to the oral method. I do agree because the study results showed this to be accurate. I do feel this is unlikely to change into practice at our institution because it would cost a lot to purchase and train staff and maintain these thermometers.
The second article “Monitoring Temperature” concluded that most participants correctly identified fever temperature but many could not identify other signs of infection or activities that could falsely elevate or depress temperature readings. I believe this is accurate because I know people don’t always ask questions and it’s easy to assume they have knowledge or understand because they don’t ask questions. Our patients have varying education levels and they receive so much information at diagnosis, it is important to remember that they can be easily overwhelmed and will not likely retain all the information.Hi Sherry,
Thank you for your response to these two articles. I chose these two articles to show how important checking temperatures is for our oncology patients and how important educating the patient temperature monitoring is as well as s/s of infection. The first article reviews the most accurate device for measuring temperature. I think it would be interesting to research if a temporal artery thermometer would benefit patients who have Grade 2 or higher mucositis, xerostomia, or febrile patients who cannot tolerate an oral for another reason vs OSU temperature probes. While the cost of a temporal artery thermometer may cost more, it may warrant a consideration especially if a patient is already febrile, unable to tolerate an oral temperature from the diagnoses of above, patient with rigors, etc. and therefore the decision to place a device to measure core temperature is made. This increases the patients risk for infection. A thought would be to have at least 1 TAT available on a unit. Similar to each unit having a bladder scanner or Doppler for pulse checks. The benefit of the patient would in my mind outweigh the cost.In regards to education, I love the idea to educated while reviewing fevers during the toxicity assessment. It should not be assumed that the patient who has undergone chemotherapy has an understanding of temperature monitoring at home or s/s of infection. Unfortunately, I have learned that there is no standard education on these topics given to patients when they first undergo chemotherapy. Asking chemotherapy nurses here about their practice on education, I was informed that they either just check to make sure they have a thermometer at home, use chemocare handouts, or just tell the patient to call their doctor if they have a fever of or above 100.4. None of the 3 nurses I spoke with stated they utilized the patient education material available at OSU. It is so important for all nurses involved in the patients plan of care assess the need for education and provide it to the patient no matter where they are in their treatment.
1.What was the knowledge gained from the article?
2.Will the research/information in this article change or influence your practice? If so how?
3.What other questions does the article raise about current practice?
4.Do you agree/disagree with the conclusions of the author, why?Good Morning – I am Mindy Blackwell – Gyn/Onc. Nice to meet you Sherry, we probably speak on the phone because we utilize ICC a lot!
1. the articles confirmed what I had suspected – many patients are not sure how to properly monitor their temps or know what to do when they are elevated vs fever. Head and Neck currently uses a temporal thermometer for their patients but the patients still use an oral thermometer at home for monitoring.
2. I will confirm with patient that they do know 100% how to take their temp and what factors could make it read higher (drinking coffee before etc.,) I will be a little more thorough with this than I have in the past.
Also, if the patient understands that illness due to neutropenia run a different and much faster course than your “everyday” colds and flus they may be more apt to comply with monitoring temperatures. I have to say my ex-coworkers on James 5 do an excellent job with their teaching about daily temperatures.3. Articles state most don’t even have a thermometer at home. I have worked in clinics that give patients thermometers and instruct them to check it daily and other clinics that only advise to check if not feeling well.
4. I agree w/ the articles that the patients are not always as informed as we assume they are and our patient education should start with assessing what they already know and then build on that.1.What was the knowledge gained from the article?
2.Will the research/information in this article change or influence your practice? If so how?
3.What other questions does the article raise about current practice?
4.Do you agree/disagree with the conclusions of the author, why?Hello I am Lachell McFadden and work on MMMT4 (Multimodality Derm/Onc)
1) The articles reaffirmed how one of the most basic of vitals signs can become a valuable assessment tool in caring for any patient. It becomes even more valuable in treating patient populations that are immunocompromised.
2) I found many times while doing phone triage, that many people do not have thermometers at home. We do not currently provide patients with thermometers but I have discussed this with my manager and we are gong to look at a way to include this with new pt teaching. I do agree that we should make sure that we are assessing both the pt and family’s understanding of temperature taking and when to report abnormals.
3) Should it become common practice to have at least one temporal artery thermometer available on each unit for those patients with mucositis or as a back up in the outpatient setting since the alternative is to take an axillary temp.
4)I do agree that it would be beneficial to have a TAT on each unit that does not have the means for more invasive temperature monitoring.
I do agree that we need to continue to assess each individuals level of understanding in regards to temperature taking, when to call with abnormal results ,various factors that may affect readings and other signs and symptoms of infection.Hi Lachelle! You suggest having a temporal in every clinic which I agree with, I don’t think Head & Neck had them until 2015 so I wonder how long it would take to get them available in every clinic? There is a project for someone….
To respond about the patient education given: I find chemocare to have a lot of good information but can be overwhelming, the OSU patient education is a little simpler and easier to follow. Some clinic RN’s do the teaching, some chemo RN’s do the teaching and some clinics have pharmacists do the teaching. That is fine but there are inconsistencies in how great of depth of the information is given. You can learn a lot by hearing what another is teaching and maybe it would be a good idea to go into the room and listed to what another is teaching every once in a while.
Hi Lachelle,
Thank you so much for your response to these articles. Temperature monitoring is a basic vital sign and it is such an important vital sign for oncology patients. This is something that patients are able to do at home. So education and making sure patients have access to a thermometer is the first step. It is great to hear that when triaging a patient on the phone, assessment of whether a patient has a home thermometer is being evaluated and educated on. Even better news is that it sounds like there will be a change on your unit and provide thermometers to your patients. This is wonderful!
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