Pre‐procedure

ActionRationale

1. 1.Show
   Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed.
   To ensure that the patient feels at ease, understands the procedure and gives their valid consent (NMC [144], C).
2. 2.Show
   If the patient is wearing a hearing aid, ask the patient to remove the device from the ear (or remove it for them if appropriate) and wait 10 minutes before taking a reading.
   To allow the temperature within the ear canal to normalize. E
3. 3.Show
   Wash and dry hands and/or use an alcohol‐based handrub.
   To minimize the risk of cross‐infection and contamination (NHS England and NHSI [124], C).

Procedure

1. 4.Show
   Inspect the ear canal for the presence of ear drainage, blood, cerebrospinal fluid, vernix, cerumen (compacted ear wax) or foreign bodies.
   The presence of these substances can affect the accuracy of the reading (Basak et al. [14], C).

   Ear wax does not affect accuracy but cerumen plugs and impactions containing debris can lower the temperature measurement by several tenths of a degree (Basak et al. [14], C).
2. 5.Show
   Remove the thermometer from the base unit and ensure the lens is clean and not cracked, and that the probe lens is free of smudges and debris. Use a dry lint‐free swab to wipe it clean if required and calibrate it according to the manufacturer's guidelines.
   Alcohol‐based wipes should not be used as this can lead to a false low temperature measurement (WelchAllyn [208], E).
3. 6.Show
   Verify the mode setting on the display to show the route (ear) by which the temperature is due to be measured.
   To ensure accuracy when interpreting the result (Grainger [75], C).
4. 7.Show
   Place a disposable probe cover on the probe tip, ensuring the manufacturer's instructions are followed, e.g. ensuring the cover is flush with the thermometer end and not touching the plastic film on the distal tip of the probe cover.
   The probe cover protects the tip of the probe and is necessary for the functioning of the instrument (WelchAllyn [208], E).
5. 8.Show
   Ensure the patient has not been lying on either ear in the 20‐minute interval immediately preceding temperature measurement. If the patient is lying on their side, always take the temperature in the exposed ear.
   Lying on an ear causes significant changes in tympanic temperature (Arslan et al. [7], C).
6. 9.Show
   Align the probe tip with the ear canal and gently advance it into the ear canal until the probe lightly seals the opening, ensuring a snug fit (see Figure 14.38).
   To prevent air at the opening of the ear from entering it, causing a false low temperature measurement (Covidien [47], C; Jevon and Ewens [88], E).
7. 10.Show
   Press and release the ‘scan’ button (the name of the button may vary between models).
   To commence the scanning (Covidien [47], C).
8. 11.Show
   Remove the probe tip from the ear as soon as the thermometer display reads ‘done’ (or equivalent) or displays the temperature reading, usually indicated by beeps. Read the temperature display and document in the patient's records (along with the ear used).
   To ensure the procedure is carried out for the necessary amount of time. Measurement is usually complete within seconds (Gasim et al. [69], E).

   Any interruption in the process may result in the measurement being incorrectly remembered (Fuller et al. [67], E).
9. 12.Show
   Obtain a reading from both ears and take the greater of the readings. A new probe cover must be used for each reading to ensure the highest degree of accuracy and to prevent cross‐contamination between the ears.
   Recent evidence suggests that any anatomical differences between the two ears are irrelevant with the newest generation of infra‐red tympanic thermometers (Haugan et al. [78], E; Salota et al. [181], E).
10. 13.Show
    Compare the result with previous results. Take action as appropriate.
    Deviations from normal temperature ranges may require urgent medical/clinical attention (NMC [144], C).

Post‐procedure

1. 14.Show
   Press the ‘release’ or ‘eject’ button (or equivalent) to discard the probe cover into a waste bin per local infection control guidelines.
   Probe covers are for single use only (Grainger [75], E).
2. 15.Show
   Wipe the thermometer clean as per the manufacturer's guidelines and return it to the base unit for storage.
   To reduce the risk of cross‐infection (NICE [127], E).