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Inaccurate body temperature measurements impact clinical decision-making and patient safety. Nurses in our large free-standing children's hospital and clinics questioned the accuracy of certain thermometer devices. Our clinical practice policy on temperatures allowed nurses to use their clinical judgment about which device and route of thermometry should be used for their patients. An audit of our hospital and clinic thermometer purchases from January to May 2014 revealed seven different devices. The purpose of this evidence-based practice (EBP) project was to select the most precise and accurate temperature-taking routes and measurement methods to set as the standard for our hospital system. The evidence-based project began with the intent to conduct a systematic review of the literature on the accuracy of non-core thermometer devices. While developing evidence tables, it became clear that the results and conclusions of the studies were so inconsistent that we could not select the most accurate thermometer devices for our hospital system. We realized only studies comparing core vs. non-core were appropriate, and a meta-analysis was required to summarize data from core vs. non-core temperatures. Evidence shows that oral and rectal electronic thermometers provided the most accurate approximation of core body temperatures. Our findings resulted in a revision of the temperature policy. One year after the policy change, unit-by-unit observations of devices showed significant usage of approved devices. This successful practice and policy change improved clinical decision-making based on more accurate and consistent body temperatures., Rapid improvements in the technology of measuring body temperature and the search for more non-invasive methods have resulted in numerous devices designed for pediatric patients. In our 464-bed, free-standing children's [...]

The literature is inconclusive on the accuracy of various thermometer devices used in clinical practice. We conducted a meta-analysis on the accuracy of temperatures from six peripheral (non-core) thermometer devices compared to core body temperature. Medline, CINAHL, and other resources were searched for articles related to body temperature and thermometer devices. From 197 articles, 159 were research and 38 were non-research. Thirty-four research articles met criteria for inclusion in the meta-analysis: core and non-core temperatures measured concurrently or sequentially, appropriate statistics, and sample size of 10 or more. We applied Cochrane GRADE criteria for diagnostic tests and strategies. Assessments of bias, indirectness of evidence, overall confidence in effect sizes, consistency, precision, and publication bias indicated low risk. The extent of heterogeneity was Q=0% for each type of thermometer device; impact of heterogeneity was 0% due to true differences, and [I.sup.2]=100% due to random sampling error. Forest plots illustrated bias (mean differences), 95% confidence limits, and confidence intervals (CI). A forest plot of the overall accuracy of non-core devices indicated that oral and rectal electronic thermometers had the least bias (-0.05[degrees]C and -0.04[degrees]C) and narrowest CI: oral=0.58[degrees]C, rectal=1.18[degrees]C, compared to temporal (1.88[degrees]C), axillary chemical (2.25[degrees]C), axillary electronic (2.36[degrees]C), and tympanic (2.62[degrees]C). Our findings indicate that only oral and rectal electronic thermometer devices should be used to measure temperature of individuals for screening, monitoring, diagnostic, and treatment decisions. Tympanic, temporal, axillary chemical, and axillary electronic thermometer devices should not be used in clinical practice., Although the use of rectal and oral thermometers has been standard practice in pediatric and adult healthcare settings, the quest for less invasive and more rapid methods of measuring body [...]