Quality statement 2: Measuring and recording vital signs

Quality statement

Infants and children under 5 years who are seen in person by a healthcare professional have their temperature, heart rate, respiratory rate and capillary refill time measured and recorded if fever is suspected.

Rationale

Measuring and recording vital signs is an essential step in assessing the risk of serious illness, aiding diagnosis and ensuring the correct course of action. Measuring vital signs includes taking the child's temperature and measuring heart rate, respiratory rate and capillary refill time. Temperature, heart rate and respiratory rate should be measured using the correct equipment for the child's age. To ensure an accurate reading, it is important that a healthcare professional measures the child's temperature even if the parent or carer has already done this. Parental or carer reports of fever should be acted on.

Quality measures

Structure

Evidence of local arrangements to ensure that temperature, heart rate, respiratory rate and capillary refill time of infants and children under 5 years with suspected fever can be measured using the correct equipment and recorded.

Data source: Local data collection.

Process

Proportion of infants and children under 5 years seen by a healthcare professional and suspected of having a fever who have their temperature, heart rate, respiratory rate and capillary refill time measured and recorded.

Numerator – the number in the denominator who have their temperature, heart rate, respiratory rate and capillary refill time measured and recorded.

Denominator – the number of infants and children under 5 years seen by a healthcare professional and suspected of having a fever.

Data source: Local data collection.

Outcome

Early identification of serious illness in infants and children under 5 years.

Data source: Local data collection.

What the quality statement means for different audiences

Service providers (such as general practice and emergency departments) ensure that the correct equipment for measuring temperature, heart rate, respiratory rate and capillary refill time is available to healthcare professionals who see infants and children under 5 years with suspected fever.

Healthcare professionals ensure that they measure and record temperature, heart rate, respiratory rate and capillary refill time using the correct equipment in infants and children under 5 years with suspected fever.

Commissioners (clinical commissioning groups and NHS England)ensure that the services they commission provide the correct equipment and training so that healthcare professionals can measure and record the temperature, heart rate, respiratory rate and capillary refill time of infants and children under 5 years with suspected fever.

Infants and children under 5 years with suspected fever have their temperature, pulse and breathing rate measured when they are seen by a healthcare professional. The healthcare professional also checks for signs of dehydration and shock, and makes sure that all measurements and observations are added to the patient records.

Source guidance

Fever in under 5s: assessment and initial management (2019) NICE guideline 143, recommendation 1.2.8

Definitions of terms used in this quality statement

Suspected fever

Fever is suspected when there is reason to believe that body temperature is raised above the normal daily variation. Healthcare professionals should take any parental reports of suspected fever seriously.

[NICE's 2013 full guideline on fever in under 5s, section 1.2 definitions]

Correct equipment

Temperature should be measured using appropriate thermometers.

[NICE's guideline on fever in under 5s, recommendation 1.1]