# Discharge and after-hours fever advice

Source: [[../policies/POL-CW-05-discharge-fever.md|POL-CW-05]] v1.4 (2 Aug 2025) · Owner: Nursing Education · **ID has not countersigned**

Teaching copy. Not KHCC policy. Not for real patients.

## The rules as written (what families are told)

- ANC = “white cells plus the bands.” Risk is high below 500.
- Fever 38.0°C and the child looks well: paracetamol, **call clinic 08:00–16:00 the next working day**.
- Fever 38.5°C after 16:00: wait until morning unless drowsy or not drinking.
- Do not rush to ER for a fever that settles with paracetamol.
- In ER, first antibiotic **within 90 minutes**. Usual drug: **ceftriaxone**.
- Every central line goes home with a **heparin lock**. Do not use saline alone.
- Come tonight only for drowsiness, mottling, not drinking, rigors after a flush, or bleeding. **Fever alone can wait.**

## Linked notes

- [[febrile-neutropenia]] — this leaflet is the opposite of POL-CW-01 sections 3, 4, and 7. POL-CW-01 required this leaflet to match the FN pathway.
- [[central-line]] — heparin-at-discharge agrees with POL-CW-02’s discharge sentence and contradicts POL-CW-02’s “no heparin on PICC/Broviac.”
- [[chemo-safety]] — same “wait until morning” habit for a well-looking fever.

## Open questions

- “White cells plus bands” is not the definition of ANC. Flag as an error.
- Highest-risk document in the folder: it is what parents take home.