An Integrative Review Focusing on Accuracy and Reliability of Clinical Thermometers

An Integrative Review Focusing on Accuracy and Reliability of Clinical Thermometers by Julie A. Black MS, University of Maryland, 1999 BS, Azusa Pacific University, 1986 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University May 2016 Abstract Technological advances in clinical thermometers have resulted in a variety of minimally invasive devices that give rapid results but may not have the accuracy necessary for use in acutely ill adults. Inaccurate temperatures can result in missed opportunities for the early identification and treatment of infection and sepsis. Following the methodology outlined by Whittemore and Knafl, the purpose of this project was to conduct an integrative review of the research on the accuracy of clinical thermometers used for acutely ill adults. The evidence was categorized using the Hierarchy of Evidence for Interventional Studies, and the quality of the studies was appraised using the indicators described by Hooper and Andrews. Forty-seven studies met the inclusion criteria; the findings on device accuracy were contradictory. Device accuracy was found in 10 (n = 27) studies on the tympanic (TM), 2 (n = 8) on the chemical dot (CH), 7 (n = 19) on the temporal artery (TAT), and 3 (n = 13) on the axillary (AX) thermometers. Two of 2 studies found the no-touch (NT) device clinically inaccurate. Diagnostic accuracy was found in 3 (n = 8) and 0 (n = 5) studies on the TM and TAT, respectively. Only 22 studies had an acceptable quality grade of A or B, limiting the validity of the evidence. The evidence did not support the use of the NT and TAT thermometers or the AX route for acutely ill adults. The CH device should be use with caution, and abnormal temperatures should be validated with a more reliable device. For thermometers in use, appropriate training and technique are essential for the most accurate results. Closing the knowledge-to-practice gap on clinical thermometers can change the culture of nursing practice, improve early sepsis identification, and increase the quality of patient care.Technological advances in clinical thermometers have resulted in a variety of minimally invasive devices that give rapid results but may not have the accuracy necessary for use in acutely ill adults. Inaccurate temperatures can result in missed opportunities for the early identification and treatment of infection and sepsis. Following the methodology outlined by Whittemore and Knafl, the purpose of this project was to conduct an integrative review of the research on the accuracy of clinical thermometers used for acutely ill adults. The evidence was categorized using the Hierarchy of Evidence for Interventional Studies, and the quality of the studies was appraised using the indicators described by Hooper and Andrews. Forty-seven studies met the inclusion criteria; the findings on device accuracy were contradictory. Device accuracy was found in 10 (n = 27) studies on the tympanic (TM), 2 (n = 8) on the chemical dot (CH), 7 (n = 19) on the temporal artery (TAT), and 3 (n = 13) on the axillary (AX) thermometers. Two of 2 studies found the no-touch (NT) device clinically inaccurate. Diagnostic accuracy was found in 3 (n = 8) and 0 (n = 5) studies on the TM and TAT, respectively. Only 22 studies had an acceptable quality grade of A or B, limiting the validity of the evidence. The evidence did not support the use of the NT and TAT thermometers or the AX route for acutely ill adults. The CH device should be use with caution, and abnormal temperatures should be validated with a more reliable device. For thermometers in use, appropriate training and technique are essential for the most accurate results. Closing the knowledge-to-practice gap on clinical thermometers can change the culture of nursing practice, improve early sepsis identification, and increase the quality of patient care. An Integrative Review Focusing on Accuracy and Reliability of Clinical Thermometers by Julie A. Black MS, University of Maryland, 1999 BS, Azusa Pacific University, 1986 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University May 2016 Dedication Above all, this project is dedicated to my heavenly Father and to my savior, Jesus Christ. Hebrews 12:1-2 says “. let us run with endurance the race set before us, fixing our eyes on Jesus. ” and we are assured in Philippians 4:13 that “I can do all things through Christ who strengthens me. ” It is through God’s grace that I have finished this race and am ready to embark on the next leg of this journey This project is also dedicated to my husband and best friend, Byron Black. No one accomplishes these monumental journeys without the love and support of family and friends. Without Byron’s love and endless encouragement, I would not have persevered to the end. Acknowledgments I would like to acknowledge, with the deepest appreciation, the time, effort, and counsel of my committee chair, Dr. Eileen Fowles. The road to the completion of this project has been filled with many passages, by-ways, and roadblocks. Dr. Fowles helped me navigate each of these challenges with the calm assurance that I would be successful in the end. I would also like to acknowledge my committee member, Dr. Catherine Harris, and my URR, Dr. Jonas Nguh, for their feedback and help through this project. A special thank you to my friends and colleagues that have prayed for me as I struggled my way from class to class and paper to paper. Without your love, support, and prayers, I would not have reached this goal.