- Email: [email protected]
Ear temperatures: Making research-based clinical decisions
It is a n e x c e l l e n t t h i n g t o l e a r n t o j u d g e of t h e c o n d i t i o n of a p a t i e n t ' s t e m p e r a t u r e b y t h e t o u c h , t r a i n i n g t h e f i n g e r s or h a n d t o feel differences, and controlling the impressions thus received with the results obtained with the thermometer.
Table 1 Ear thermometry: Measurement
Isabel H a m p t o n (1898) 1
emergency nurses, we were thrilled at the conc e p t of e a r t h e r m o m e t e r s ; e a r t e m p e r a t u r e m e a surement was purportedly clean, quick, and painfree. But what about consistent and accurate? A few years ago salespeople demonstrated ear thermometers at our hospital; after reviewing the product literature we b o u g h t five t h e r m o m e t e r s for o u r a d u l t e m e r g e n c y department. After a quick education session we began to routinely assess ear temperature at triage and throughout our department. Our experiences s u p p o r t e d t h e a d v e r t i s i n g c l a i m of e a r t h e r m o m e t r y a s quick and easy. However, we began to notice isolated c a s e s of i n c o n s i s t e n c i e s i n t e m p e r a t u r e s . F o r e x a m ple, a f t e r m e a s u r i n g a n d d o c u m e n t i n g a n e a r t e m p e r a t u r e of 35.8 ~ C a t t r i a g e , t h e p r i m a r y n u r s e w o u l d n o t i c e a w a r m s k i n t e m p e r a t u r e or r a p i d r e s p i r a t o r y r a t e , obtain a rectal temperature measurement, and disc o v e r t h e p a t i e n t w a s febrile. W e w o n d e r e d a b o u t t h i s i n c o n s i s t e n c y . O n e of t h e e m e r g e n c y p h y s i c i a n s w a s s k e p t i c a l of t h e a c c u r a c y of e a r t e m p e r a t u r e s ; b e c a u s e of h i s p e n c h a n t for t e c h n o l o g y a s s e s s m e n t , h e di-
A
s
Ms. Koziol-McLain is instructor and assistant director, Colorado Emergency Medical Research Center, Denver, Colorado, and an emergency nurse, University Hospital, Denver. Ms. Oman is clinical nurse educator, Emergency Department, University Hospital, Denver. Ms. Edwards is a staff nurse, Emergency Department, University Hospital, Denver. For reprints, write Jane Koziol-McLain, RN, MS, 7360 S. Tamarac Ct., Englewood, CO 80112. J EMERGNURS 1996;22:77-9 Copyright 9 1996 by the Emergency Nurses Association. 0099-1767/96 $5.00 + 0 18/1/71103
Site peculiarities
Best
comparison
Ear site
state of the research
T e m p e r a t u r e m e a s u r e m e n t , as all m e a s u r e m e n t , is inexact. For example, t h e r e a r e i n s t r u m e n t errors a n d t e c h n i q u e errors. Oral t e m p e r a t u r e m e a s u r e m e n t s have b e e n found to b e inaccurate in certain conditions (tachypnea, incorrect t h e r m o m e t e r probe placement, after p a t i e n t drinks hot or cold liquids); t h e s e i n a c c u r a c i e s a r e most likely c o m p o u n d e d in a triage setting. Rectal t e m p e r a t u r e readings are approximately 0.6 ~ C higher t h a n core t e m p e r a t u r e s a n d r e s p o n d slowly to rapid t e m p e r a t u r e changes. A m b i e n t air affects oral a n d ear m e a s u r e m e n t s . Pulmonary artery t e m p e r a t u r e is considered t h e most accurate "core" t e m p e r a t u r e a n d serves as t h e gold s t a n d a r d against which o t h e r methods m u s t be judged. Therefore comparing ear m e a s u r e m e n t s with oral or rectal m e a s u r e m e n t s is problematic. Ear t e m p e r a t u r e is different from core temperature. Rather t h a n creating a d j u s t m e n t s in software programs, Terndrup et alfi r e c o m m e n d making decisions b a s e d on u n a d j u s t e d "normal ear temperatures."
February 1996
7~
JOURNAL OF EMERGENCY NURSING/Kozio1-McLain,Oman, and Edwards
r e c t e d a r e s e a r c h s t u d y in our d e p a r t m e n t . 2 The s t u d y c o m p a r e d ear a n d rectal t e m p e r a t u r e s a n d found that t h e r e were i n a c c u r a c i e s . W h e n the s t u d y results were p r e s e n t e d to the n u r s e s , w e quickly critiqued t h e s t u d y b e c a u s e only ear a n d rectal t e m p e r a t u r e s h a d b e e n m e a s u r e d , n o t a n s w e r i n g the q u e s t i o n w h e t h e r our i n a c c u r a c y with ear t e m p e r a t u r e m e a s u r e m e n t
W e f o r m e d a j o u r n a l c l u b to review the literature, identify clinical issues, and to m a k e a d e c i s i o n r e g a r d i n g w h a t t y p e of t h e r m o m e t e r to u s e in our department.
w a s b e t t e r or worse t h a n w i t h oral t e m p e r a t u r e m e a s u r e m e n t . In practice, w e k n e w t h a t oral t h e r m o m e ter p r o b e s were n o t correctly p l a c e d in the posterior s u b l i n g u a l pocket a n d t h a t oral t e m p e r a t u r e s were s o m e t i m e s i n a p p r o p r i a t e l y m e a s u r e d in t a c h y p n e i c p a t i e n t s or in p a t i e n t s w h o h a d recently d r u n k hot or cold liquids. 3-6 Therefore w e still faced the d i l e m m a of
w h e t h e r the ear t h e r m o m e t e r should replace the oral t h e r m o m e t e r i n our d e p a r t m e n t . The p r o b l e m w o r s e n e d several m o n t h s ago w h e n two p a t i e n t s were misciassified as afebrile at triage on the b a s i s of their ear t e m p e r a t u r e m e a s u r e m e n t s a n d later Were identified as febrile. The e m e r g e n c y physicians, i n a knee-jerk reaction, said, "No more tymp a n i c t h e r m o m e t e r s . " S i n c e t h e n w e have had m a n y informal a n d formal d i s c u s s i o n s a b o u t the topic. T h e p h y s i c i a n s finally a g r e e d t h a t t e m p e r a t u r e m e a s u r e m e n t w a s in the p u r v i e w of n u r s i n g a n d that t h e n u r s e s should d e c i d e w h a t m e t h o d to use. They were c o n f i d e n t t h a t w e could r e v i e w the literature, w h i c h they a c k n o w l e d g e d w a s controversial, a n d they would r e s p e c t our decision. We formed a journal club to review the literature, identify clinical issues, a n d to m a k e a d e c i s i o n reg a r d i n g w h a t type of t h e r m o m e t e r to u s e in our d e p a r t m e n t . Three articles w e r e selected, copied, a n d d i s t r i b u t e d to all n u r s e s in our d e p a r t m e n t along with the flyer for t h e journal club. T h e first two articles w e r e c o a u t h o r e d b y a n u r s e a n d p h y s i c i a n , 7, s who both h a d e x t e n s i v e p u b l i c a t i o n in the area of thermometry. The final article d e s c r i b e d t h e s t u d y in our d e p a r t m e n t . 1 O n t h e d a y of the journal club m e e t i n g the staff m e m b e r s w h o usually a t t e n d our journal clubs were present: t h e d e p a r t m e n t educator, clinical supervisor, researcher, a n d several s e l e c t e d staff nurses. It w a s d i s a p p o i n t i n g t h a t more staff n u r s e s did not attend, d e s p i t e m a n y n u r s e s w h o h a d e x p r e s s e d emotional
Table 2 Comparison of selected research studies on ear temperature measurement Study authors
Sample
Measurements
Findings
Erikson and Meyer 7
50 a d u l t s in i n t e n s i v e care unit
Ear t e m p e r a t u r e v e r s u s pulmonary artery temperature
Ear v e r s u s p u l m o n a r y a r t e r y d i f f e r e n c e s varied a m o n g p a t i e n t s ; s t a n d a r d d e v i a t i o n in d i f f e r e n c e w a s -+0.4 to 0.5 ~ C a m o n g t h e several t h e r m o m e t e r s
C h a m b e r l a i n e t al. 8
2447 h e a l t h y p e r s o n s of
Three ear measurements in e a c h p e r s o n
T h e u p p e r c u t o f f for "normal" (99% of s a m ple) e a r t e m p e r a t u r e s in p e r s o n s 12 y e a r s a n d o l d e r w a s 37.6 ~ C. Ear v e r s u s r e c t a l differences w e r e ~1 ~ C in 10% of s a m p l e . S e n s i t i v i t y of d e t e c t i n g a f e v e r (39.5~ C) w a s 60% a n d s p e c i f i c i t y w a s 98%.
tested. all a g e s
Y a r o n e t al. 2
78
Volume 22, Number 1
100 a d u l t s in a n e m e r gency department
Ear t e m p e r a t u r e v e r s u s rectal temperature
Koziol-McLain,Oman, and Edwards/JOURNAL OF EMERGENCY NURSING
feelings a b o u t t h e route of t e m p e r a t u r e m e a s u r e m e n t u s e d for s c r e e n i n g p a t i e n t s in our d e p a r t m e n t . It s e e m e d that the d i l e m m a h a d b e c o m e either u n i m portant, or t h e y t r u s t e d u s to m a k e the right decision. The journal club p l a n n e d the following topics: (1) a r e v i e w of s e l e c t e d r e s e a r c h articles, (2) a r e v i e w of the i s s u e s r e g a r d i n g oral a n d rectal t e m p e r a t u r e m e a s u r e m e n t , (3) d i s c u s s i o n of t e c h n i q u e a n d m a i n t e n a n c e i s s u e s w e h a d l e a r n e d in talking w i t h the produ c t r e p r e s e n t a t i v e , (4) i s s u e s a b o u t collaboration with p h y s i c i a n s , a n d (5) m a k i n g a decision. W e quickly c o m p l e t e d t h e first four topics, b u t t h e n w e r e a c h e d t h e final s t e p - - m a k i n g a decision. In s u m m a r y , w e
We developed a standard p r o c e d u r e for t e m p e r a t u r e measurement that included taking ear temperature r e a d i n g s in b o t h e a r s for a 6-month period so that each individual nurse could learn whether the temperatures being taken were repeatable and measures w e c o u l d t a k e to m a k e t h e m SO.
c o n s i d e r e d that: (1) e v i d e n c e s u g g e s t s t h a t ear t e m p e r a t u r e m e a s u r e m e n t s occasionally misclassify pat i e n t s as afebrile w h e n t h e y are i n d e e d febrile, (2) w e w e r e not s u p e r s t a r s at t a k i n g oral t e m p e r a t u r e s , (3) s o m e m e a s u r e s could b e i m p l e m e n t e d to b e t t e r m a i n t a i n t h e ear t h e r m o m e t e r s , s u c h as regular m a i n t e n a n c e a n d calibration s c h e d u l i n g , (4) w e w e r e u n sure if our ear m e a s u r e m e n t t e c h n i q u e w a s the b e s t it could be, a n d (5) ear t e m p e r a t u r e s save t i m e a n d are liked b y p a t i e n t s . We d e c i d e d to try ear t h e r m o m e t e r s again, yet b e c a u t i o u s a n d a t t e n d to the i s s u e of accuracy. We developed a n e d u c a t i o n p r o g r a m involving the p r o d u c t r e p r e s e n t a t i v e w h o c a m e to the d e p a r t m e n t a n d edu c a t e d us. We d e v e l o p e d a s t a n d a r d p r o c e d u r e for
t e m p e r a t u r e m e a s u r e m e n t t h a t i n c l u d e d t a k i n g ear t e m p e r a t u r e r e a d i n g s in both ears for a 6 - m o n t h period so t h a t e a c h i n d i v i d u a l n u r s e could learn w h e t h e r the t e m p e r a t u r e s b e i n g t a k e n w e r e r e p e a t a b l e a n d m e a s u r e s w e could take to m a k e t h e m so. During this t i m e m a n y of u s l e a r n e d w h a t a correct "seal" w a s b y t a k i n g our o w n t e m p e r a t u r e . We also e m p h a s i z e d t h a t in s o m e c a s e s a n ear t e m p e r a t u r e m e a s u r e m e n t should b e followed u p with a n oral or rectal t e m p e r a ture a s s e s s m e n t b y the p r i m a r y nurse. W e n o w t h i n k before w e m e a s u r e (temperature) in our d e p a r t m e n t ; w e c o n s i d e r the p a t i e n t a n d the m e t h o d . After 6 m o n t h s w e will r e e v a l u a t e our decision c o n s i d e r i n g our experience, p r o d u c t improvem e n t s , a n d a n y n e w p u b l i s h e d research. We m a y choose a n o t h e r plan later, b u t w e n o w believe w e have a plan that is both s e n s i b l e a n d r e s e a r c h based. References
1. Hampton IA. Nursing: its principles and practice. 2nd ed. Cleveland, Ohio: E.C. Koeckert, 1898:187. 2. Yaron M, Lowenstein SR, Koziol-McLainJ. Measuring the accuracy of the infrared tympanic thermometer: correlation does not signify agreement. J Emerg Med 1995;13:617-21. 3. Doyle F, Zehner WJ, Terndrup TE. The effect of ambient temperature extremes on tympanic and oral temperatures. Am J Emerg Med 1992;10:285-9. 4. Franceschi VT. Accuracy and feasibility of measuring oral temperature in critically ill adults. Focus Crit Care 1991;18:221-8. 5. Longman AJ, Verran JA, Ayoub J, Neff J, Noyes A. Research utilization: an evaluation and critique of research related to oral temperature measurement. AppI Nurs Res 1990;3:14 9. 6. Terndrup TE, Allegra JR, Kealy JAr A comparison of oral, rectal, and tympanic membrane-derived temperature changes after ingestion of liquids and smoking. Am J Emerg Med 1989;7:150-4. 7. Ericksen RS, Meyer LT. Accuracy of infrared ear thermometry and other temperature methods in adults. Am J Crit Care 1994;3:40-54. 8. Chamberlain JM, Terndrup TE, Alexander DT, et al. Determination of normal ear temperature with an infrared emission detection thermometer. Ann Emerg Med 1995; 25:15-20.
C o n t r i b u t i o n s for this c o l u m n should b e s e n t to J a n e Koziol-McLain, RN, MS, 7360 S. T a m a r a c Court, Englewood, CO 80112; p h o n e (303) 2704553.
February 1996
79
Table 1 Ear thermometry: Measurement
Isabel H a m p t o n (1898) 1
emergency nurses, we were thrilled at the conc e p t of e a r t h e r m o m e t e r s ; e a r t e m p e r a t u r e m e a surement was purportedly clean, quick, and painfree. But what about consistent and accurate? A few years ago salespeople demonstrated ear thermometers at our hospital; after reviewing the product literature we b o u g h t five t h e r m o m e t e r s for o u r a d u l t e m e r g e n c y department. After a quick education session we began to routinely assess ear temperature at triage and throughout our department. Our experiences s u p p o r t e d t h e a d v e r t i s i n g c l a i m of e a r t h e r m o m e t r y a s quick and easy. However, we began to notice isolated c a s e s of i n c o n s i s t e n c i e s i n t e m p e r a t u r e s . F o r e x a m ple, a f t e r m e a s u r i n g a n d d o c u m e n t i n g a n e a r t e m p e r a t u r e of 35.8 ~ C a t t r i a g e , t h e p r i m a r y n u r s e w o u l d n o t i c e a w a r m s k i n t e m p e r a t u r e or r a p i d r e s p i r a t o r y r a t e , obtain a rectal temperature measurement, and disc o v e r t h e p a t i e n t w a s febrile. W e w o n d e r e d a b o u t t h i s i n c o n s i s t e n c y . O n e of t h e e m e r g e n c y p h y s i c i a n s w a s s k e p t i c a l of t h e a c c u r a c y of e a r t e m p e r a t u r e s ; b e c a u s e of h i s p e n c h a n t for t e c h n o l o g y a s s e s s m e n t , h e di-
A
s
Ms. Koziol-McLain is instructor and assistant director, Colorado Emergency Medical Research Center, Denver, Colorado, and an emergency nurse, University Hospital, Denver. Ms. Oman is clinical nurse educator, Emergency Department, University Hospital, Denver. Ms. Edwards is a staff nurse, Emergency Department, University Hospital, Denver. For reprints, write Jane Koziol-McLain, RN, MS, 7360 S. Tamarac Ct., Englewood, CO 80112. J EMERGNURS 1996;22:77-9 Copyright 9 1996 by the Emergency Nurses Association. 0099-1767/96 $5.00 + 0 18/1/71103
Site peculiarities
Best
comparison
Ear site
state of the research
T e m p e r a t u r e m e a s u r e m e n t , as all m e a s u r e m e n t , is inexact. For example, t h e r e a r e i n s t r u m e n t errors a n d t e c h n i q u e errors. Oral t e m p e r a t u r e m e a s u r e m e n t s have b e e n found to b e inaccurate in certain conditions (tachypnea, incorrect t h e r m o m e t e r probe placement, after p a t i e n t drinks hot or cold liquids); t h e s e i n a c c u r a c i e s a r e most likely c o m p o u n d e d in a triage setting. Rectal t e m p e r a t u r e readings are approximately 0.6 ~ C higher t h a n core t e m p e r a t u r e s a n d r e s p o n d slowly to rapid t e m p e r a t u r e changes. A m b i e n t air affects oral a n d ear m e a s u r e m e n t s . Pulmonary artery t e m p e r a t u r e is considered t h e most accurate "core" t e m p e r a t u r e a n d serves as t h e gold s t a n d a r d against which o t h e r methods m u s t be judged. Therefore comparing ear m e a s u r e m e n t s with oral or rectal m e a s u r e m e n t s is problematic. Ear t e m p e r a t u r e is different from core temperature. Rather t h a n creating a d j u s t m e n t s in software programs, Terndrup et alfi r e c o m m e n d making decisions b a s e d on u n a d j u s t e d "normal ear temperatures."
February 1996
7~
JOURNAL OF EMERGENCY NURSING/Kozio1-McLain,Oman, and Edwards
r e c t e d a r e s e a r c h s t u d y in our d e p a r t m e n t . 2 The s t u d y c o m p a r e d ear a n d rectal t e m p e r a t u r e s a n d found that t h e r e were i n a c c u r a c i e s . W h e n the s t u d y results were p r e s e n t e d to the n u r s e s , w e quickly critiqued t h e s t u d y b e c a u s e only ear a n d rectal t e m p e r a t u r e s h a d b e e n m e a s u r e d , n o t a n s w e r i n g the q u e s t i o n w h e t h e r our i n a c c u r a c y with ear t e m p e r a t u r e m e a s u r e m e n t
W e f o r m e d a j o u r n a l c l u b to review the literature, identify clinical issues, and to m a k e a d e c i s i o n r e g a r d i n g w h a t t y p e of t h e r m o m e t e r to u s e in our department.
w a s b e t t e r or worse t h a n w i t h oral t e m p e r a t u r e m e a s u r e m e n t . In practice, w e k n e w t h a t oral t h e r m o m e ter p r o b e s were n o t correctly p l a c e d in the posterior s u b l i n g u a l pocket a n d t h a t oral t e m p e r a t u r e s were s o m e t i m e s i n a p p r o p r i a t e l y m e a s u r e d in t a c h y p n e i c p a t i e n t s or in p a t i e n t s w h o h a d recently d r u n k hot or cold liquids. 3-6 Therefore w e still faced the d i l e m m a of
w h e t h e r the ear t h e r m o m e t e r should replace the oral t h e r m o m e t e r i n our d e p a r t m e n t . The p r o b l e m w o r s e n e d several m o n t h s ago w h e n two p a t i e n t s were misciassified as afebrile at triage on the b a s i s of their ear t e m p e r a t u r e m e a s u r e m e n t s a n d later Were identified as febrile. The e m e r g e n c y physicians, i n a knee-jerk reaction, said, "No more tymp a n i c t h e r m o m e t e r s . " S i n c e t h e n w e have had m a n y informal a n d formal d i s c u s s i o n s a b o u t the topic. T h e p h y s i c i a n s finally a g r e e d t h a t t e m p e r a t u r e m e a s u r e m e n t w a s in the p u r v i e w of n u r s i n g a n d that t h e n u r s e s should d e c i d e w h a t m e t h o d to use. They were c o n f i d e n t t h a t w e could r e v i e w the literature, w h i c h they a c k n o w l e d g e d w a s controversial, a n d they would r e s p e c t our decision. We formed a journal club to review the literature, identify clinical issues, a n d to m a k e a d e c i s i o n reg a r d i n g w h a t type of t h e r m o m e t e r to u s e in our d e p a r t m e n t . Three articles w e r e selected, copied, a n d d i s t r i b u t e d to all n u r s e s in our d e p a r t m e n t along with the flyer for t h e journal club. T h e first two articles w e r e c o a u t h o r e d b y a n u r s e a n d p h y s i c i a n , 7, s who both h a d e x t e n s i v e p u b l i c a t i o n in the area of thermometry. The final article d e s c r i b e d t h e s t u d y in our d e p a r t m e n t . 1 O n t h e d a y of the journal club m e e t i n g the staff m e m b e r s w h o usually a t t e n d our journal clubs were present: t h e d e p a r t m e n t educator, clinical supervisor, researcher, a n d several s e l e c t e d staff nurses. It w a s d i s a p p o i n t i n g t h a t more staff n u r s e s did not attend, d e s p i t e m a n y n u r s e s w h o h a d e x p r e s s e d emotional
Table 2 Comparison of selected research studies on ear temperature measurement Study authors
Sample
Measurements
Findings
Erikson and Meyer 7
50 a d u l t s in i n t e n s i v e care unit
Ear t e m p e r a t u r e v e r s u s pulmonary artery temperature
Ear v e r s u s p u l m o n a r y a r t e r y d i f f e r e n c e s varied a m o n g p a t i e n t s ; s t a n d a r d d e v i a t i o n in d i f f e r e n c e w a s -+0.4 to 0.5 ~ C a m o n g t h e several t h e r m o m e t e r s
C h a m b e r l a i n e t al. 8
2447 h e a l t h y p e r s o n s of
Three ear measurements in e a c h p e r s o n
T h e u p p e r c u t o f f for "normal" (99% of s a m ple) e a r t e m p e r a t u r e s in p e r s o n s 12 y e a r s a n d o l d e r w a s 37.6 ~ C. Ear v e r s u s r e c t a l differences w e r e ~1 ~ C in 10% of s a m p l e . S e n s i t i v i t y of d e t e c t i n g a f e v e r (39.5~ C) w a s 60% a n d s p e c i f i c i t y w a s 98%.
tested. all a g e s
Y a r o n e t al. 2
78
Volume 22, Number 1
100 a d u l t s in a n e m e r gency department
Ear t e m p e r a t u r e v e r s u s rectal temperature
Koziol-McLain,Oman, and Edwards/JOURNAL OF EMERGENCY NURSING
feelings a b o u t t h e route of t e m p e r a t u r e m e a s u r e m e n t u s e d for s c r e e n i n g p a t i e n t s in our d e p a r t m e n t . It s e e m e d that the d i l e m m a h a d b e c o m e either u n i m portant, or t h e y t r u s t e d u s to m a k e the right decision. The journal club p l a n n e d the following topics: (1) a r e v i e w of s e l e c t e d r e s e a r c h articles, (2) a r e v i e w of the i s s u e s r e g a r d i n g oral a n d rectal t e m p e r a t u r e m e a s u r e m e n t , (3) d i s c u s s i o n of t e c h n i q u e a n d m a i n t e n a n c e i s s u e s w e h a d l e a r n e d in talking w i t h the produ c t r e p r e s e n t a t i v e , (4) i s s u e s a b o u t collaboration with p h y s i c i a n s , a n d (5) m a k i n g a decision. W e quickly c o m p l e t e d t h e first four topics, b u t t h e n w e r e a c h e d t h e final s t e p - - m a k i n g a decision. In s u m m a r y , w e
We developed a standard p r o c e d u r e for t e m p e r a t u r e measurement that included taking ear temperature r e a d i n g s in b o t h e a r s for a 6-month period so that each individual nurse could learn whether the temperatures being taken were repeatable and measures w e c o u l d t a k e to m a k e t h e m SO.
c o n s i d e r e d that: (1) e v i d e n c e s u g g e s t s t h a t ear t e m p e r a t u r e m e a s u r e m e n t s occasionally misclassify pat i e n t s as afebrile w h e n t h e y are i n d e e d febrile, (2) w e w e r e not s u p e r s t a r s at t a k i n g oral t e m p e r a t u r e s , (3) s o m e m e a s u r e s could b e i m p l e m e n t e d to b e t t e r m a i n t a i n t h e ear t h e r m o m e t e r s , s u c h as regular m a i n t e n a n c e a n d calibration s c h e d u l i n g , (4) w e w e r e u n sure if our ear m e a s u r e m e n t t e c h n i q u e w a s the b e s t it could be, a n d (5) ear t e m p e r a t u r e s save t i m e a n d are liked b y p a t i e n t s . We d e c i d e d to try ear t h e r m o m e t e r s again, yet b e c a u t i o u s a n d a t t e n d to the i s s u e of accuracy. We developed a n e d u c a t i o n p r o g r a m involving the p r o d u c t r e p r e s e n t a t i v e w h o c a m e to the d e p a r t m e n t a n d edu c a t e d us. We d e v e l o p e d a s t a n d a r d p r o c e d u r e for
t e m p e r a t u r e m e a s u r e m e n t t h a t i n c l u d e d t a k i n g ear t e m p e r a t u r e r e a d i n g s in both ears for a 6 - m o n t h period so t h a t e a c h i n d i v i d u a l n u r s e could learn w h e t h e r the t e m p e r a t u r e s b e i n g t a k e n w e r e r e p e a t a b l e a n d m e a s u r e s w e could take to m a k e t h e m so. During this t i m e m a n y of u s l e a r n e d w h a t a correct "seal" w a s b y t a k i n g our o w n t e m p e r a t u r e . We also e m p h a s i z e d t h a t in s o m e c a s e s a n ear t e m p e r a t u r e m e a s u r e m e n t should b e followed u p with a n oral or rectal t e m p e r a ture a s s e s s m e n t b y the p r i m a r y nurse. W e n o w t h i n k before w e m e a s u r e (temperature) in our d e p a r t m e n t ; w e c o n s i d e r the p a t i e n t a n d the m e t h o d . After 6 m o n t h s w e will r e e v a l u a t e our decision c o n s i d e r i n g our experience, p r o d u c t improvem e n t s , a n d a n y n e w p u b l i s h e d research. We m a y choose a n o t h e r plan later, b u t w e n o w believe w e have a plan that is both s e n s i b l e a n d r e s e a r c h based. References
1. Hampton IA. Nursing: its principles and practice. 2nd ed. Cleveland, Ohio: E.C. Koeckert, 1898:187. 2. Yaron M, Lowenstein SR, Koziol-McLainJ. Measuring the accuracy of the infrared tympanic thermometer: correlation does not signify agreement. J Emerg Med 1995;13:617-21. 3. Doyle F, Zehner WJ, Terndrup TE. The effect of ambient temperature extremes on tympanic and oral temperatures. Am J Emerg Med 1992;10:285-9. 4. Franceschi VT. Accuracy and feasibility of measuring oral temperature in critically ill adults. Focus Crit Care 1991;18:221-8. 5. Longman AJ, Verran JA, Ayoub J, Neff J, Noyes A. Research utilization: an evaluation and critique of research related to oral temperature measurement. AppI Nurs Res 1990;3:14 9. 6. Terndrup TE, Allegra JR, Kealy JAr A comparison of oral, rectal, and tympanic membrane-derived temperature changes after ingestion of liquids and smoking. Am J Emerg Med 1989;7:150-4. 7. Ericksen RS, Meyer LT. Accuracy of infrared ear thermometry and other temperature methods in adults. Am J Crit Care 1994;3:40-54. 8. Chamberlain JM, Terndrup TE, Alexander DT, et al. Determination of normal ear temperature with an infrared emission detection thermometer. Ann Emerg Med 1995; 25:15-20.
C o n t r i b u t i o n s for this c o l u m n should b e s e n t to J a n e Koziol-McLain, RN, MS, 7360 S. T a m a r a c Court, Englewood, CO 80112; p h o n e (303) 2704553.
February 1996
79