Dr Nazia Hussain identifies five key learning points for primary care from the updated NICE guideline on the assessment and initial management of fever in children under 5 years old

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Implementation actions for STPs and ICSs

written by Dr David Jenner, GP, Cullompton, Devon

The following implementation actions are designed to support STPs and ICSs with the challenges involved with implementing new guidance at a system level. Our aim is to help you consider how to deliver improvements to healthcare within the available resources.

  • Establish a multi-professional team led by paediatricians to consider these guidelines and the challenges of applying them in both primary and secondary care
  • Review any triage systems in operation by GP, out-of-hours providers, and 111 services to ensure that they have been updated to accommodate these guidelines
  • Ensure any digital consultation tools are also compliant with these guidelines, including those using artificial intelligence or ‘chatbots’
  • Consider providing (or signposting to) online symptom checkers for members of the public to access, and advertise their presence on other nationally provided services such as NHS 111 online
  • Publish and disseminate the useful ‘traffic light’ guidance charts to all frontline health providers, including pharmacies.

STP=sustainability and transformation partnership; ICS=integrated care system

The guideline discussed in this article was produced by the Guideline Updates Team for the National Institute for Health and Care Excellence (NICE). The views expressed in this article are those of the author and not necessarily those of NICE.

National Institute for Health and Care Excellence (2019). Fever in under 5s: assessment and initial management. Available from www.nice.org.uk/guidance/ng143

References

  1. NICE. Fever in under 5s: assessment and initial management. NICE Guideline 143. NICE, 2019. Available at: www.nice.org.uk/guidance/ng143
  2. NICE. Feverish children—management. NICE Clinical Knowledge Summary. NICE, 2018. Available at: cks.nice.org.uk/feverish-children-management
  3. Hay A, Heron J, Ness A and the ALSPAC study team. The prevalence of symptoms and consultations in pre-school children in the Avon Longitudinal Study of Parents and Children (ALSPAC): a prospective cohort study. Family Practice 2005; 22 (4): 367–374.
  4. Tambe P, Sammons H, Choonara I. Why do young children die in the UK? A comparison with Sweden. Arch Dis Child  2015; 100: 928-931.
  5. NICE. Sepsis: recognition, diagnosis and early management. NICE Guideline 51. NICE 2016. Available at: www.nice.org.uk/guidance/ng51
  6. NICE. Neonatal infection (early onset): antibiotics for prevention and treatment. Clinical Guideline 149. NICE 2012. Available at: www.nice.org.uk/guidance/cg149
  7. NICE. Meningitis (bacterial) and meningococcal septicaemia in under 16s: recognition, diagnosis and management. Clinical Guideline 102. NICE 2010. Available at: www.nice.org.uk/guidance/cg102
  8. NICE. Urinary tract infection in under 16s: diagnosis and management. Clinical Guideline 54. NICE 2007. Available at: www.nice.org.uk/guidance/cg54
  9. NICE. Diarrhoea and vomiting caused by gastroenteritis in under 5s: diagnosis and management. Clinical Guideline 84. NICE, 2009. Available at: www.nice.org.uk/guidance/cg84
  10. NICE. Antimicrobial prescribing for common infections overview. NICE Pathways. NICE 2019. Available at: pathways.nice.org.uk/pathways/antimicrobial-prescribing-for-common-infections
  11. Hall G, Tulloh L, Tulloh R. Kawasaki disease incidence in children and adolescents: an observational study in primary care. Br J Gen Pract 2016; 66 (645): e271–e276.
  12. Newburger J, Takahashi M, Gerber M et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Pediatrics 2004; 114 (6): 1708–1733.
  13. Oates-Whitehead R, Baumer J, Haines L et al. Intravenous immunoglobulin for the treatment of Kawasaki disease in children. Cochrane Database Syst Rev 2003; (4): CD004000.