Quality standard

Quality statement 4: Safety net advice

Quality statement 4: Safety net advice

Quality statement

Parents and carers who are advised that they can care for an infant or child under 5 years with unexplained fever at home are given safety net advice, including information on when to seek further help.

Rationale

Sometimes a healthcare professional advises parents and carers to care for their child at home. This may be because the child is at low risk of serious illness or they may have been stratified as medium risk but the decision has been made to care for them at home. Advice about what to do and what to look out for (safety net advice) empowers parents and carers to seek help if the child's condition deteriorates further or if they need more support. If a child's condition deteriorates it is important that they are seen again quickly.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

Evidence of local arrangements to ensure that safety net advice, which includes information on when to seek further help, is available for parents and carers who are advised they can care for an infant or child under 5 years with unexplained fever at home.

Data source: Local data collection.

Process

Proportion of infants and children under 5 years with unexplained fever who are being cared for at home after assessment by a healthcare professional, whose parents and carers are given safety net advice, including information on when to seek further help.

Numerator – the number of infants and children in the denominator whose parents and carers receive safety net advice that includes information on when to seek further help.

Denominator – the number of infants and children under 5 years with unexplained fever who are being cared for at home after assessment by a healthcare professional.

Data source: Local data collection.

Outcome

Parent and carer experience of services.

Data source: Local data collection.

What the quality statement means for different audiences

Service providers (such as general practice and emergency departments) ensure that written and verbal safety net advice is given to parents and carers when infants and children under 5 years with unexplained fever are cared for at home. This information should explain when the parent or carer should seek further help and should be available in formats that take account of literacy, language and other communication barriers.

Healthcare professionals provide parents and carers with safety net advice when an infant or child under 5 years with unexplained fever is cared for at home. This advice should include information on when the parent or carer should seek further help and should be given in a format the parents and carers can understand. The advice should usually be given as written material with some verbal discussion of the content.

Commissioners (clinical commissioning groups and NHS England) ensure that the services they commission can demonstrate that parents and carers are provided with safety net advice in an appropriate format when infants and children under 5 years with unexplained fever are cared for at home. This could include evidence that the advice accounts for any literacy, language or other communication barriers.

Parents and carers who are caring for an infant or child under 5 years with unexplained fever at home are given advice about what to do, what to look out for and when to get further help.

Source guidance

Fever in under 5s: assessment and initial management. NICE guideline NG143 (2019, updated 2021), recommendations 1.3.5, 1.4.4, 1.4.5 and 1.5.25

Definitions of terms used in this quality statement

Fever

Fever is an elevation of body temperature 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]

Safety net advice

Advise parents or carers looking after a feverish child at home:

  • to offer the child regular fluids (where a baby or child is breastfed the most appropriate fluid is breast milk)

  • how to detect signs of dehydration by looking for the following features:

    • sunken fontanelle

    • dry mouth

    • sunken eyes

    • absence of tears

    • poor overall appearance

  • to encourage their child to drink more fluids and consider seeking further advice if they detect signs of dehydration

  • how to identify a non-blanching rash

  • to check their child during the night

  • to keep their child away from nursery or school while the child's fever persists but to notify the school or nursery of the illness.

[NICE's guideline on fever in under 5s, recommendation 1.7.2]

When to seek further help

Following contact with a healthcare professional, parents and carers who are looking after their feverish child at home should seek further advice if:

  • the child has a fit

  • the child develops a non-blanching rash

  • the parent or carer feels that the child is less well than when they previously sought advice

  • the parent or carer is more worried than when they previously sought advice

  • the fever lasts 5 days or longer

  • the parent or carer is distressed, or concerned that they are unable to look after their child.

[NICE's guideline on fever in under 5s, recommendation 1.7.3]

See also the discharge advice template for NICE's guideline on fever in under 5s.

Equality and diversity considerations

Healthcare professionals should take into consideration the communication needs of the parents and carers when deciding on the best format for safety net advice.

A non-blanching rash may be harder to detect in infants and children with darker skin tones, and healthcare professionals should inform parents and carers that it may be easier to identify a rash on the palms of the hands, the conjunctivae and the soles of the feet.