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Lind JN, Lovegrove MC, Paul IM, Yin HS, Budnitz DS. Changes in Provider Perceptions and Practices Regarding Dosing Units for Oral Liquid Medications. Acad Pediatr 2024; 24:627-632. [PMID: 37666391 PMCID: PMC10919552 DOI: 10.1016/j.acap.2023.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/08/2023] [Accepted: 08/28/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVE A 2015 survey of primary care providers (PCPs) found that while many believed that milliliter (mL)-only dosing was safest for oral liquid medications, few would use mL alone in dosing instructions. Since 2015, many recommendations have promoted "mL-only" dosing. In 2019, a follow-up survey was conducted to assess if PCP perceptions and practices have changed. METHODS Pediatricians, family medicine physicians, nurse practitioners, and internists participating in the 2015 and 2019 DocStyles cross-sectional, web-based surveys were asked about their perceptions and practices regarding dosing units for oral liquid medications. RESULTS In 2019, among 1392 respondents, the proportion of PCPs who reported they believed using mL-only is the safest dosing instruction ranged from 55.1% of internists to 80.8% of pediatricians. While fewer PCPs believed patients/caregivers prefer dosing instructions in mL-only (23.9% of nurse practitioners to 48.4% of pediatricians), more held this belief in 2019 compared to 2015; pediatricians had the greatest absolute increase (+14.4%) and family medicine physicians had the smallest increase (+1.3%). While 61.6% of pediatricians reported they would use mL-only dosing, only 36.0% of internists, 36.6% of nurse practitioners, and 42.5% of family medicine physicians reported they would do so. After controlling for age, gender, region, and specialty, 2019 PCP survey participants were more likely to report that they would use mL-only dosing compared to 2015 participants (adjusted odds ratio 1.51, 95% confidence interval 1.29-1.77). CONCLUSIONS Broader educational efforts may be necessary to reach nonpediatricians, to encourage prescribing and communication with patients/caregivers using mL-only dosing.
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Affiliation(s)
- Jennifer N Lind
- Division of Healthcare Quality Promotion (JN Lind, MC Lovegrove, and DS Budnitz), Centers for Disease Control and Prevention, Atlanta, GA.
| | - Maribeth C Lovegrove
- Division of Healthcare Quality Promotion (JN Lind, MC Lovegrove, and DS Budnitz), Centers for Disease Control and Prevention, Atlanta, GA.
| | - Ian M Paul
- Departments of Pediatrics and Public Health Sciences (IM Paul), Penn State College of Medicine, Hershey, PA.
| | - Hsiang Shonna Yin
- Departments of Pediatrics and Population Health (HS Yin), New York University Grossman School of Medicine, New York, NY.
| | - Daniel S Budnitz
- Division of Healthcare Quality Promotion (JN Lind, MC Lovegrove, and DS Budnitz), Centers for Disease Control and Prevention, Atlanta, GA.
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Balıkçı BB, Güneş Ü. Accuracy of liquid drug dose measurements using different tools by caregivers: a prospective observational study. Eur J Pediatr 2024; 183:853-862. [PMID: 37875630 DOI: 10.1007/s00431-023-05293-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 10/07/2023] [Accepted: 10/15/2023] [Indexed: 10/26/2023]
Abstract
This study aimed to assess the accuracy of liquid drug dose measurements made by caregivers and explore the factors influencing these measurements. Caregivers (n = 176) of children aged less than 8 years, who were treated at the pediatric clinic of a university hospital in Turkey between July and October 2019, were eligible to participate in this study. The caregivers' ability to accurately measure a 2.5-mL dose of medication was observed using standardized measurement instruments, including 15-mL and 30-mL dosing cups, a 3-mL dropper, a 5-mL dose spoon, and a 5-mL oral syringe. A comparison was made with the reference weight determined for the 2.5-mL dose to calculate the margin of error. A dose of ± 20% of the reference value was considered a clinically significant error. The chi-square test was used to examine differences in dose error rates concerning individual characteristics. Caregivers exhibited a dosing error rate exceeding 20%. Specifically, 43% of the errors occurred when using 15-mL cups, 37% with 30-mL cups, 22% with 3-mL droppers, 4.5% with 5-mL spoons, and 4% with 5-mL syringes. In cases where errors were under 20%, the rates were as follows: 1.1% with 15-mL cups, 2.8% with 30-mL cups, 19% with 3-mL droppers, 3.4% with 5-mL spoons, and 4% with 5-mL syringes. The dosing errors were not affected by the role and health literacy level of caregivers, regardless of the type of dosing tool they used (all p values > 0.05). The study found that oral syringes and dosing spoons had the lowest error rates, whereas dosing cups had the highest error rates. Conclusion: Healthcare providers in family health centers and pediatric clinics should educate caregivers about proper drug administration with oral syringes and dosing spoons, even if dosing cups are included. What is Known: • Dose calculation errors and incorrect measurement tools are the leading factors causing errors. • Liquid medicine bottles are still often accompanied by dosing cups as measuring instruments. • Both the American Academy of Pediatrics (AAP) and the U.S. Food and Drug Administration (FDA) recommend that parents use standard measuring instruments such as oral syringes, droppers, and measuring spoons instead of kitchen spoons for administering the correct dose to children. What is New: • The measuring tool with the maximum errors was the dosing cup, whereas oral syringes and dosing spoons were more accurate. • Individual administering medication at home and the health literacy level had no effect on the accuracy of dose measurement. • Pediatric nurses, in particular, should incorporate safe liquid medication measurement tools into parental education.
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Affiliation(s)
- Burcu Bayraktar Balıkçı
- Department of Anesthesiology and Reanimation, Faculty of Medicine Hospital, Ege University, 35040, Izmir, Turkey.
| | - Ülkü Güneş
- Department of Fundamentals of Nursing, Faculty of Nursing, Ege University, 35040, Izmir, Turkey
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Carroll AR, Johnson JA, Stassun JC, Greevy RA, Mixon AS, Williams DJ. Health Literacy-Informed Communication to Reduce Discharge Medication Errors in Hospitalized Children: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2350969. [PMID: 38227315 DOI: 10.1001/jamanetworkopen.2023.50969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2024] Open
Abstract
Importance Inadequate communication between caregivers and clinicians at hospital discharge contributes to medication dosing errors in children. Health literacy-informed communication strategies during medication counseling can reduce dosing errors but have not been tested in the pediatric hospital setting. Objective To test a health literacy-informed communication intervention to decrease liquid medication dosing errors compared with standard counseling in hospitalized children. Design, Setting, and Participants This parallel, randomized clinical trial was performed from June 22, 2021, to August 20, 2022, at a tertiary care, US children's hospital. English- and Spanish-speaking caregivers of hospitalized children 6 years or younger prescribed a new, scheduled liquid medication at discharge were included in the analysis. Interventions Permuted block (n = 4) randomization (1:1) to a health literacy-informed discharge medication communication bundle (n = 99) compared with standard counseling (n = 99). A study team member delivered the intervention consisting of a written, pictogram-based medication instruction sheet, teach back (caregivers state information taught), and demonstration of dosing with show back (caregivers show how they would draw the liquid medication in the syringe). Main Outcome and Measures Observed dosing errors, assessed using a caregiver-submitted photograph of their child's medication-filled syringe and expressed as the percentage difference from the prescribed dose. Secondary outcomes included caregiver-reported medication knowledge. Outcome measurements were blinded to participant group assignment. Results Among 198 caregivers randomized (mean [SD] age, 31.4 [6.5] years; 186 women [93.9%]; 36 [18.2%] Hispanic or Latino and 158 [79.8%] White), the primary outcome was available for 151 (76.3%). The observed mean (SD) percentage dosing error was 1.0% (2.2 percentage points) among the intervention group and 3.3% (5.1 percentage points) among the standard counseling group (absolute difference, 2.3 [95% CI, 1.0-3.6] percentage points; P < .001). Twenty-four of 79 caregivers in the intervention group (30.4%) measured an incorrect dose compared with 39 of 72 (54.2%) in the standard counseling group (P = .003). The intervention enhanced caregiver-reported medication knowledge compared with the standard counseling group for medication dose (71 of 76 [93.4%] vs 55 of 69 [79.7%]; P = .03), duration of administration (65 of 76 [85.5%] vs 49 of 69 [71.0%]; P = .04), and correct reporting of 2 or more medication adverse effects (60 of 76 [78.9%] vs 13 of 69 [18.8%]; P < .001). There were no differences in knowledge of medication name, indication, frequency, or storage. Conclusions and Relevance A health literacy-informed discharge medication communication bundle reduced home liquid medication administration errors and enhanced caregiver medication knowledge compared with standard counseling. Routine use of these standardized strategies can promote patient safety following hospital discharge. Trial Registration ClinicalTrials.gov Identifier: NCT05143047.
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Affiliation(s)
- Alison R Carroll
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Jakobi A Johnson
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Justine C Stassun
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Robert A Greevy
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Amanda S Mixon
- Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Internal Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Derek J Williams
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, Tennessee
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Rickey L, Auger K, Britto MT, Rodgers I, Field S, Odom A, Lehr M, Cronin A, Walsh KE. Measurement of Ambulatory Medication Errors in Children: A Scoping Review. Pediatrics 2023; 152:e2023061281. [PMID: 37986581 DOI: 10.1542/peds.2023-061281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/20/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Children use most medications in the ambulatory setting where errors are infrequently intercepted. There is currently no established measure set for ambulatory pediatric medication errors. We have sought to identify the range of existing measures of ambulatory pediatric medication errors, describe the data sources for error measurement, and describe their reliability. METHODS We performed a scoping review of the literature published since 1986 using PubMed, CINAHL, PsycINFO, Web of Science, Embase, and Cochrane and of grey literature. Studies were included if they measured ambulatory, including home, medication errors in children 0 to 26 years. Measures were grouped by phase of the medication use pathway and thematically by measure type. RESULTS We included 138 published studies and 4 studies from the grey literature and identified 21 measures of medication errors along the medication use pathway. Most measures addressed errors in medication prescribing (n = 6), and administration at home (n = 4), often using prescription-level data and observation, respectively. Measures assessing errors at multiple phases of the medication use pathway (n = 3) frequently used error reporting databases and prospective measurement through direct in-home observation. We identified few measures of dispensing and monitoring errors. Only 31 studies used measurement methods that included an assessment of reliability. CONCLUSIONS Although most available, reliable measures are too resource and time-intensive to assess errors at the health system or population level, we were able to identify some measures that may be adopted for continuous measurement and quality improvement.
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Affiliation(s)
- Lisa Rickey
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Katherine Auger
- Division of Hospital Medicine
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Maria T Britto
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Isabelle Rodgers
- Section of Pediatric Infectious Diseases, Boston Medical Center, Boston, Massachusetts
| | - Shayna Field
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Alayna Odom
- Division of Hospital Medicine
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Madison Lehr
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | | | - Kathleen E Walsh
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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Nadeshkumar A, Sathiadas G, Sri Ranganathan S. Quality of measuring devices enclosed with paediatric oral liquid dosage forms of medicines registered in Sri Lanka. PLoS One 2023; 18:e0294690. [PMID: 37992067 PMCID: PMC10664896 DOI: 10.1371/journal.pone.0294690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 11/06/2023] [Indexed: 11/24/2023] Open
Abstract
INTRODUCTION Oral liquid dosage forms remain popular in several middle income countries. The accuracy of liquid dosage form dosing depends on the accuracy and availability of measuring devices. Lack of quality oral liquid measuring devices will lead to medication errors. Hence there is an urgent need to describe the quality of manufacturer supplied measuring devices enclosed with paediatric oral liquid dosage forms currently registered in Sri Lanka. METHODOLOGY Standards for measuring devices were developed after a detailed literature search. Multidisciplinary panel rated each standard for the necessity criteria on a 9 point Likert scale. Standards with overall panel median score of ≥ 7 with agreement were selected. A cross-sectional study was done. All the measuring devices, labels and instructions enclosed with the registered products were assessed against the standards developed. Three volumes of liquid antibacterials were measured using the enclosed measuring device. Accuracy of the volumes was measured. RESULTS Of the total products (n = 202) only 126 were packed with a dosing device. Around quarter of the oral liquid dosage forms (n = 36) did not have a measuring device. More than half of the measuring devices aligned with all the standards developed. Out of 44 oral liquid paediatric antimicrobials measuring cups (n = 25, 56.8%, 95% CI: 41%-72%) were enclosed more and less error was seen with measuring cups. CONCLUSION The quality of oral liquid measuring devices were not satisfactory. Quality could be further improved if the regulatory body request the manufactures/importers to adhere to the standards developed. Correct volumes were not measured using the measuring devices provided with the liquid antimicrobial agents.
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Affiliation(s)
- Abarna Nadeshkumar
- Faculty of Allied Health Sciences, Department of Pharmacy and Pharmaceutical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
- Faculty of Medicine, Department of Pharmacology, University of Colombo, Colombo, Sri Lanka
| | - Gitanjali Sathiadas
- Faculty of Medicine, Department of Paediatrics, University of Jaffna, Jaffna, Sri Lanka
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Carroll AR, Schlundt D, Bonnet K, Mixon AS, Williams DJ. Caregiver and Clinician Perspectives on Discharge Medication Counseling: A Qualitative Study. Hosp Pediatr 2023; 13:325-342. [PMID: 36987806 PMCID: PMC10071429 DOI: 10.1542/hpeds.2022-006937] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
OBJECTIVES Children are at increased risk for medication errors and the transition from hospital-to-home is a vulnerable time for errors to occur. This study aimed to explore the perspectives of multidisciplinary clinicians and caregivers regarding discharge medication counseling and to develop a conceptual model to inform intervention efforts to reduce discharge medication dosing errors. METHODS We conducted semistructured interviews with clinicians and caregivers of children <4 years old discharged from the hospital on a liquid medication. A hierarchical coding system was developed using the interview guide and several transcripts. Qualitative analysis employed an iterative inductive-deductive approach to identify domains and subthemes and inform a conceptual framework. RESULTS We conducted focus groups and individual interviews with 17 caregivers and 16 clinicians. Using the Donabedian structure-process-outcomes model of quality evaluation, domains and subthemes included: (1) infrastructure of healthcare delivery, including supplies for counseling, content and organization of discharge instructions, clinician training and education, roles and responsibilities of team members, and hospital pharmacy delivery and counseling program; (2) processes of healthcare delivery, including medication reconciliation, counseling content, counseling techniques, and language barriers and health literacy; and (3) measurable outcomes, including medication dosing accuracy and caregiver understanding and adherence to discharge instructions. CONCLUSIONS The conceptual model resulting from this analysis can be applied to the development and evaluation of interventions to reduce discharge medication dosing errors following a hospitalization. Interventions should use a health literacy universal precautions approach-written materials with plain language and pictures and verbal counseling with teach-back and show-back.
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Affiliation(s)
- Alison R. Carroll
- Divisions of Pediatric Hospital Medicine, Department of Pediatrics, Monroe Carell Jr. Children’s Hospital at Vanderbilt
| | - David Schlundt
- Department of Psychology (College of Arts and Science), Vanderbilt University, Nashville, Tennessee
| | - Kemberlee Bonnet
- Vanderbilt Center for Health Services Research, Qualitative Research Core, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Amanda S. Mixon
- Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Internal Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Derek J. Williams
- Divisions of Pediatric Hospital Medicine, Department of Pediatrics, Monroe Carell Jr. Children’s Hospital at Vanderbilt
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Younas E, Fatima M, Alvina A, Nawaz HA, Anjum SM, Usman M, Pervaiz M, Shabbir A, Rasheed H. Correct administration aid for oral liquid medicines: Is a household spoon the right choice? Front Public Health 2023; 11:1084667. [PMID: 36891337 PMCID: PMC9986283 DOI: 10.3389/fpubh.2023.1084667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 01/30/2023] [Indexed: 02/22/2023] Open
Abstract
Background Correct medicine dosing is an important component in the safe and effective delivery of medicines, particularly for the pediatric population. However, there is a scarcity of public campaigns on the correct administration and choice of dosing aids for oral liquid dosage form in many countries, leading to medicine safety issues and therapeutic failures. Methods The study targeted the assessment of the knowledge and practice of university students. It utilizes pre- and post-intervention surveys administered through google forms as a survey tool during online zoom and in-person sessions. The intervention included a short video presentation detailing the selection and use of medicine spoons and other aids for the administration of oral liquid dosage. The Fischer Exact test was used to assess the pre- and post-test shift of responses. Results Nine-degree programs were engaged in the activity, and 108 students attended this health awareness activity after obtaining formal consent. A significant decline (CI = 95%, **** p-value < 0.05) in the choice of selecting tablespoon and a shift to a low-volume spoon, as well as rejection of an entire variety of household spoons, were observed. A significant improvement in the correct naming of spoons, the meaning of the abbreviation "tsp," and the correct volume of a standard teaspoon were also observed with a p-value of <0.001. Conclusion A deficit in the knowledge of the proper use of measuring devices for oral liquid medicines in the educated population was observed, which can be enhanced through simple tools like short video presentations and awareness seminars.
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Affiliation(s)
- Eman Younas
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Moomna Fatima
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Ayesha Alvina
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Hafiz Awais Nawaz
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Syed Muneeb Anjum
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Muhammad Usman
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Mehak Pervaiz
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Amara Shabbir
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Huma Rasheed
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
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AlKaddour NA, Shah RB, Gillani SW, Sharafi NH, Khan AF, Elshafie RM, Rathore HA. A cross-sectional survey among parents to report challenges and barriers in the administration of drugs to children. F1000Res 2022; 11:1431. [PMID: 37065930 PMCID: PMC10090859 DOI: 10.12688/f1000research.123317.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/24/2022] [Indexed: 12/12/2022] Open
Abstract
Background: Lack of knowledge among parents can result in inappropriate administration practices. After analyzing different studies among children, there was no data on challenges and barriers in the administration of drugs among children in this region because of the diverse environmental issues and challenges in the UAE. The objective of this study was to determine the reported administration practices of parents and challenges and barriers in the administration of drugs among children in UAE. Methods: A questionnaire-based survey was conducted. A convenience sampling technique was used to collect the data. An online Raosoft® sample size calculator was applied (n = 248). The inclusion criteria were parents who had a child under 10 years of age and gave consent to participate in this study. Children with vision problems, cognitive/physical disabilities, and caregivers other than parents were excluded from this study. Results: The study reported response rate of 73.2%. The mean ± S.D age of the parents in years was 35.5 ± 7.8, and the mean ± S.D of children aged years was 2.60 ± 1.54. The majority of parents (83.9%) completing the survey were mothers and resided in the city (97.2%). When the children did not like taking tablet drugs 41.9% used multiple practices and 26.2% of parents reported treatment failure due to oral drug administration. Around 47.6% of those who were interviewed reported that their children had swallowing problems during the administration of oral medication. A total of 22.2% of parents reported that they gave drugs in doses higher than prescribed by the doctor to treat their children more quickly. Similarly, a total of 64.5% of the parents reported self-medication without consultation from a healthcare provider. Conclusions: The study concluded that there were inappropriate drug administration practices among parents. Parents reported administration of higher doses to treat their children quickly.
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Affiliation(s)
- Nour Aliyan AlKaddour
- Department of Pharmacy Practice, Gulf Medical University, Ajman, United Arab Emirates
| | - Rawa Banoori Shah
- Department of Pharmacy Practice, Gulf Medical University, Ajman, United Arab Emirates
| | - Syed Wasif Gillani
- Department of Pharmacy Practice, Gulf Medical University, Ajman, United Arab Emirates
| | - Niloofar Hadi Sharafi
- Department of Pharmacy Practice, Gulf Medical University, Ajman, United Arab Emirates
| | - Aiman Fatima Khan
- Department of Pharmacy Practice, Gulf Medical University, Ajman, United Arab Emirates
| | - Riham Mohamed Elshafie
- Clinical and Hospital Pharmacy Department, College of Pharmacy, Taibah University, Al Madinah Al Munawwarah, Saudi Arabia
- Clinical Pharmacy Department, ASUSH, Ain Shams University, Cairo, Egypt
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Bedard P, Winsor GL, Garlock ES, Azad MB, Becker AB, Mandhane PJ, Moraes TJ, Sears MR, Turvey SE, Subbarao P, Brinkman FSL, Kozyrskyj AL. From Prescription Drugs to Natural Health Products: Medication Use in Canadian Infants. CHILDREN 2022; 9:children9101475. [PMID: 36291411 PMCID: PMC9600175 DOI: 10.3390/children9101475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/25/2022] [Accepted: 09/26/2022] [Indexed: 11/28/2022]
Abstract
Limited data exist on pharmaceutical product use by infants, although available data suggests higher prevalence of use among children under 12 months of age. We conducted a descriptive study of 3050 infants recruited in the CHILD Cohort Study, a prospective, multicenter, longitudinal cohort following children from pregnancy through childhood. Parents were surveyed for use of prescription and over-the-counter drugs, and natural health products (NHPs, including homeopathic products and vitamins) at 3, 6, and 12 months after delivery. By one year of age, 96.0% of children had taken at least one pharmaceutical product. Among 307 reported products, 32 were given to at least 1% of cohort infants. Vitamin D, acetaminophen, ibuprofen, topical hydrocortisone, amoxicillin, and nystatin were the most common medications and natural health products (NHPs) received, with 8/32 of the most frequently used products being NHPs. Overall, 14.7% of pharmaceutical products administered to children were off-label and 35.8% were NHPs or products without a Drug Identification Number (DIN). The use of over-the-counter medications and NHPs is common and off-label use of drugs is frequent, even in the first year of life. This study highlights the importance of conducting studies on medication use in infants, and of infant medication use monitoring by healthcare providers.
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Affiliation(s)
- Pascal Bedard
- Department of Pharmacy, CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada
| | - Geoffrey L. Winsor
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - Emma S. Garlock
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - Meghan B. Azad
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB R3A 1S1, Canada
- Children’s Hospital Research Institute of Manitoba, Winnipeg, MB R3E 3P4, Canada
| | - Allan B. Becker
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB R3A 1S1, Canada
| | - Piush J. Mandhane
- Department of Pediatrics, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Theo J. Moraes
- Department of Pediatrics, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Malcolm R. Sears
- Department of Medicine, McMaster University, Hamilton, ON L8P 1H6, Canada
| | - Stuart E. Turvey
- Department of Pediatrics, BC Children’s Hospital and The University of British Columbia, Vancouver, BC V6H 0B3, Canada
| | - Padmaja Subbarao
- Department of Pediatrics, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Fiona S. L. Brinkman
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
- Correspondence: (F.S.L.B.); (A.L.K.)
| | - Anita L. Kozyrskyj
- Department of Pediatrics, University of Alberta, Edmonton, AB T6G 1C9, Canada
- Correspondence: (F.S.L.B.); (A.L.K.)
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Brown SV, Patterson R, Davidson T, Rozette NA. Evaluation of a Pharmacist-Driven Pediatric Dose Rounding Protocol. J Pediatr Pharmacol Ther 2022; 27:636-640. [DOI: 10.5863/1551-6776-27.7.636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 11/29/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE
Medication errors are 3 times more likely to occur in pediatric populations due to calculation and rounding errors. The objective of this study was to determine the effect of a pharmacist-driven pediatric dose rounding protocol on the dose rounding of medications, measurable volumes of inpatient and discharge prescriptions, and potential cost savings.
METHODS
This single center, quasi-experimental study evaluated patients younger than or equal to 18 years of age prescribed intravenous or enteral liquid medications during an inpatient, observation, or emergency department encounter. The primary outcome of rate of measurable dose volumes was evaluated pre- and post-implementation of the protocol. Secondary outcomes, including the number of discharge prescriptions affected by pharmacist dose rounding, an evaluation of protocol effect, and prescriptions dose rounded to limit the number of packages per dose, were evaluated using a cross-sectional analysis of the post-group.
RESULTS
Four hundred seventy-seven patients and 1060 medications were evaluated in a 1-month period. The rate of measurable volumes increased from 72% to 93% in the post-group (p = 0.0001). In the post-group, 197 patients had 313 medications dose rounded by pharmacists per protocol. Of the 55 discharge medications in the post-group, 21 prescriptions (38%) matched inpatient orders that had been dose rounded by pharmacists. Twenty-four medications were rounded down to a whole package size resulting in an estimated cost savings of $117 (approximately $1400 per year).
CONCLUSIONS
Implementation of a pharmacist-driven dose rounding protocol significantly increased the rate of measurable volumes administered to pediatric patients at our institution.
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Affiliation(s)
- Shannon V. Brown
- Department of Pharmacy (SVB, RP, TD, NAR), Carilion Roanoke Memorial Hospital and Carilion Children's Hospital, Roanoke, VA
| | - Richard Patterson
- Department of Pharmacy (SVB, RP, TD, NAR), Carilion Roanoke Memorial Hospital and Carilion Children's Hospital, Roanoke, VA
| | - Tamara Davidson
- Department of Pharmacy (SVB, RP, TD, NAR), Carilion Roanoke Memorial Hospital and Carilion Children's Hospital, Roanoke, VA
| | - Nicole A. Rozette
- Department of Pharmacy (SVB, RP, TD, NAR), Carilion Roanoke Memorial Hospital and Carilion Children's Hospital, Roanoke, VA
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11
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Cullen SM, Osorio SN, Abramson EA, Kyvelos E. Improving Caregiver Understanding of Liquid Acetaminophen Administration at Primary Care Visits. Pediatrics 2022; 150:188487. [PMID: 35909148 DOI: 10.1542/peds.2021-054807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/06/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Liquid medication dosing errors are common in pediatrics. Our outpatient clinic identified gaps in caregiver education based on a 2015 American Academy of Pediatrics policy statement on prescribing liquid medications. This quality improvement (QI) initiative sought to improve caregiver's understanding of liquid acetaminophen administration at the 2-month well-child visit from 30% to 70% over a 32-month period. METHODS A resident-led interdisciplinary QI team performed sequential interventions to improve our outcome measure: the percentage of caregivers with an adequate understanding of 4 essential components of liquid acetaminophen administration (name, indication, dose, and frequency). Outcome data were collected via a 4-item verbal assessment of caregiver's understanding by nursing staff, with correct answers to all items considered adequate understanding. Process measures (medications prescribed and education provided), and balancing measures (anticipatory guidance items discussed) were gathered via electronic health record review. Shewhart "P" charts and established rules for detecting special cause variation were used to analyze data. Scatter plots assessed the association between the provision of syringes and caregiver understanding of medication administration. RESULTS In 636 caregivers, overall understanding of medication use improved from 39.8% to 74%. Knowledge of accurate dosage improved from 50.9% to 76.8%. Correlation between syringe provision and caregiver understanding was strong (R = .84). CONCLUSIONS Resident-led QI improved caregiver's understanding of liquid acetaminophen administration in infants. The most impactful interventions were implementation of English and Spanish pictograms and provision of dose-demarcated oral syringes, coupled with teach-back. Future interventions will examine generalizability to other medications and expansion to other services.
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Affiliation(s)
| | | | - Erika A Abramson
- Departments of Pediatrics.,Population Health Sciences, Weill Cornell Medical Center and New York-Presbyterian Hospital, New York, New York
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12
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Chung AM, Padgett E, Eiland LS. Evaluation of pediatric electives and core pediatric topics offered at United States schools and colleges of pharmacy. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022. [DOI: 10.1002/jac5.1587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Allison M. Chung
- Auburn University Harrison School of Pharmacy Mobile Alabama USA
| | | | - Lea S. Eiland
- Auburn University Harrison School of Pharmacy Mobile Alabama USA
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13
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AlKaddour NA, Shah RB, Gillani SW, Sharafi NH, Khan AF, Elshafie RM, Rathore HA. A cross-sectional survey among parents to report challenges and barriers in the administration of medicines to children in United Arab Emirates. F1000Res 2022; 11:1431. [PMID: 37065930 PMCID: PMC10090859 DOI: 10.12688/f1000research.123317.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 04/19/2023] Open
Abstract
Background: Lack of knowledge among parents can result in inappropriate administration practices. After analyzing different studies among children, there was no data on challenges and barriers in the administration of medicines among children in this region because of the diverse environmental issues and challenges in the UAE. The objective of this study was to determine the reported administration practices of parents and challenges and barriers in the administration of medicines among children in UAE. Methods: A questionnaire-based survey was conducted. A convenience sampling technique was used to collect the data. An online Raosoft® sample size calculator was applied (n = 248). The inclusion criteria were parents who had a child under 10 years of age and gave consent to participate in this study. Children with vision problems, cognitive/physical disabilities, and caregivers other than parents were excluded from this study. Results: The study reported response rate of 73.2%. The mean ± S.D age of the parents in years was 35.5 ± 7.8, and the mean ± S.D of children aged years was 2.60 ± 1.54. 26.2% of parents reported treatment failure due to oral medicine administration. A total of 22.2% of parents reported that they gave medicines in doses higher than prescribed by the doctor to treat their children more quickly. Similarly, a total of 64.5% of the parents reported self-medication without consultation from a healthcare provider. Conclusions: The study concluded that there were inappropriate medicine administration practices among parents. Parents reported administration of higher doses to treat their children quickly.
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Affiliation(s)
- Nour Aliyan AlKaddour
- Department of Pharmacy Practice, Gulf Medical University, Ajman, United Arab Emirates
| | - Rawa Banoori Shah
- Department of Pharmacy Practice, Gulf Medical University, Ajman, United Arab Emirates
| | - Syed Wasif Gillani
- Department of Pharmacy Practice, Gulf Medical University, Ajman, United Arab Emirates
| | - Niloofar Hadi Sharafi
- Department of Pharmacy Practice, Gulf Medical University, Ajman, United Arab Emirates
| | - Aiman Fatima Khan
- Department of Pharmacy Practice, Gulf Medical University, Ajman, United Arab Emirates
| | - Riham Mohamed Elshafie
- Clinical and Hospital Pharmacy Department, College of Pharmacy, Taibah University, Al Madinah Al Munawwarah, Saudi Arabia
- Clinical Pharmacy Department, ASUSH, Ain Shams University, Cairo, Egypt
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14
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Yin HS, Neuspiel DR, Paul IM, Franklin W, Tieder JS, Adirim T, Alvarez F, Brown JM, Bundy DG, Ferguson LE, Gleeson SP, Leu M, Mueller BU, Connor Phillips S, Quinonez RA, Rea C, Rinke ML, Shaikh U, Shiffman RN, Vickers Saarel E, Spencer Cockerham SP, Mack Walsh K, Jones B, Adler AC, Foster JH, Green TP, Houck CS, Laughon MM, Neville K, Reigart JR, Shenoi R, Sullivan JE, Van Den Anker JN, Verhoef PA. Preventing Home Medication Administration Errors. Pediatrics 2021; 148:183379. [PMID: 34851406 DOI: 10.1542/peds.2021-054666] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Medication administration errors that take place in the home are common, especially when liquid preparations are used and complex medication schedules with multiple medications are involved; children with chronic conditions are disproportionately affected. Parents and other caregivers with low health literacy and/or limited English proficiency are at higher risk for making errors in administering medications to children in their care. Recommended strategies to reduce home medication errors relate to provider prescribing practices; health literacy-informed verbal counseling strategies (eg, teachback and showback) and written patient education materials (eg, pictographic information) for patients and/or caregivers across settings (inpatient, outpatient, emergency care, pharmacy); dosing-tool provision for liquid medication measurement; review of medication lists with patients and/or caregivers (medication reconciliation) that includes prescription and over-the-counter medications, as well as vitamins and supplements; leveraging the medical home; engaging adolescents and their adult caregivers; training of providers; safe disposal of medications; regulations related to medication dosing tools, labeling, packaging, and informational materials; use of electronic health records and other technologies; and research to identify novel ways to support safe home medication administration.
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Affiliation(s)
- H Shonna Yin
- Departments of Pediatrics and Population Health, Grossman School of Medicine, New York University, New York, New York
| | | | - Ian M Paul
- Departments of Pediatrics and Public Health Sciences, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
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15
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Pawellek M, Kopf FM, Egger N, Dresch C, Matterne U, Brandstetter S. Pathways linking parental health literacy with health behaviours directed at the child: a scoping review. Health Promot Int 2021; 37:6403923. [PMID: 34668013 DOI: 10.1093/heapro/daab154] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Health literacy (HL) is thought to be crucial for the management of the manifold demands relating to child health which parents are faced with. Albeit many studies have investigated parental HL and health behaviours (HBs) directed at the child, knowledge about the pathways which link parental HL with HB is scarce. The aim of this scoping review was to identify and comprehensively describe the variety of pathways linking parental HL with HBs directed at the child which were empirically analysed in previous studies. Following established scoping review methods database searches were conducted in MEDLINE, EMBASE, PsycINFO and WebofScience on 5 March 2020. Eligibility criteria included primary, empirical studies assessing parental HL and HB directed at the child in the general parent population. Titles and abstracts were screened independently by six reviewers for potentially relevant publications and data were extracted using standardized data extraction forms. The search identified 6916 articles for title and abstract screening. After full-text review, 50 studies were included in this review. Most studies (N = 24) assumed a direct association between HL and HBs and only few studies (N = 4) used more complex models investigating different pathways or mediation and/or moderation models. Overall, the evidence on the underlying pathways linking parental HL and HBs directed at the child is mixed and fairly limited. Therefore, hypothesis-driven research and integration of results into theoretical frameworks is needed for advancing both the research on HL and public health practice.
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Affiliation(s)
- Maja Pawellek
- University Children's Hospital Regensburg (KUNO), University of Regensburg, Klinik St. Hedwig, Steinmetzstr. 1-3, Regensburg 93049, Germany.,Member of the Research and Development Campus Regensburg (WECARE), Hospital St. Hedwig of the Order of St. John, Regensburg, Germany
| | - Felicitas Maria Kopf
- University Children's Hospital Regensburg (KUNO), University of Regensburg, Klinik St. Hedwig, Steinmetzstr. 1-3, Regensburg 93049, Germany
| | - Nina Egger
- Department of Public Health and Health Education, Freiburg University of Education, Kunzenweg 21, Freiburg 79117, Germany
| | - Carolin Dresch
- Department of Research Methods, Freiburg University of Education, Kunzenweg 21, Freiburg 79117, Germany
| | - Uwe Matterne
- Medical Faculty, Institute of Social Medicine and Health Systems Research, Otto von Guericke University, Leipziger Str. 44, Magdeburg 39120, Germany
| | - Susanne Brandstetter
- University Children's Hospital Regensburg (KUNO), University of Regensburg, Klinik St. Hedwig, Steinmetzstr. 1-3, Regensburg 93049, Germany.,Member of the Research and Development Campus Regensburg (WECARE), Hospital St. Hedwig of the Order of St. John, Regensburg, Germany
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16
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Yarar C, Yakut A, Carman KB, Sahin S, Kocak O, Ozkan S, Bal C. Metoclopramide-Induced Acute Dystonia: Data From a Pediatric Emergency Unit. Pediatr Emerg Care 2021; 37:e528-e533. [PMID: 32118836 DOI: 10.1097/pec.0000000000001960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Metoclopramide is a commonly used medication in pediatric practice, and dystonia is a common adverse effect of it. The present study aims to evaluate the clinical characteristics of metoclopramide-induced acute dystonic reactions (MIADRs) in pediatric patients admitted to the pediatric emergency unit. METHODS Twenty-eight patients were admitted with MIADRs between June 2004 and April 2016; they were enrolled into the study retrospectively. RESULTS The study group was composed of 13 females and 15 males with the mean ± SD age of the females higher than that of the males, 12.3 ± 4.5 and 7.8 ± 4.3 years, respectively. Only 9 (32.1%) of the patients were diagnosed as MIADRs at the time of admission. Seventeen patients (60.7%) received over the recommended daily dose of metoclopramide. Dystonia was focal in most of the patients, with the most affected parts consisting of the neck, eyes, and orolingual regions. In 9 of the patients, the dystonia was episodic in nature. Pharmacological treatment was used for 18 patients. No patients died, and none suffered long-term injury related to MIADRs. CONCLUSIONS Metoclopramide administration may be associated with the occurrence of acute dystonic reaction. Metoclopramide-induced acute dystonic reactions may be misdiagnosed, so detailed medical history gathering and a high index of suspicion are warranted. Our data suggest that MIADRs may be dose related and that there may be age- and sex-related differences in the epidemiology of MIADRs.
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Affiliation(s)
| | | | | | - Sabiha Sahin
- Pediatric Emergency, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir
| | - Ozan Kocak
- Department of Pediatric Neurology, Samsun Education and Research Hospital, Samsun
| | | | - Cengiz Bal
- Biostatistics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
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17
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Lopez-Pineda A, Gonzalez de Dios J, Guilabert Mora M, Mira-Perceval Juan G, Mira Solves JJ. A systematic review on pediatric medication errors by parents or caregivers at home. Expert Opin Drug Saf 2021; 21:95-105. [PMID: 34251951 DOI: 10.1080/14740338.2021.1950138] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Introduction: Medication errors (MEs) are frequent and, in some cases, can lead to hospitalization, disability, increased healthcare costs or, even, death. Most of pediatric medications are administered by parents or caregivers at home. It is necessary to explore the MEs at home to improve pediatric patient safety.Areas covered: This study aimed to review the current literature on the frequency of pediatric MEs by parents or caregivers at home, their associated factors, and pediatric ME reporting systems. Citable original articles of any type of study design or reviews published from 2013 to 2021 were searched in Medline, Scopus, Embase, and ScienceDirect databases.Expert opinion: The available data about the frequency of pediatric MEs at home varied from 30% to 80%. Current research suggests the risk of making a ME in pediatric patients at home may depend on the characteristics of the caregiver and may increase if a prescription contains ≥3 drugs. Findings conclude that providing dosing tools more closely matched to prescribed dose volumes, recommending the use of syringes as a measurement tool, and educational intervention for caregivers could be useful to reduce MEs. Concerning the reporting systems for pediatric MEs in the outpatient setting, no information was found.
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Affiliation(s)
- Adriana Lopez-Pineda
- Clinical Medicine Department, Miguel Hernández University, San Juan de Alicante, Spain.,The Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Alicante, Spain
| | - Javier Gonzalez de Dios
- Paediatrics Department, Miguel Hernández University, San Juan De Alicante, Spain.,Paediatrics Department, General University Hospital of Alicante, Alicante, Spain.,Institute of Health and Biomedical Research of Alicante Alicante, Spain
| | | | | | - Jose Joaquín Mira Solves
- The Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Alicante, Spain.,Health Psychology Department, Miguel Hernández University, Elche, Spain.,Prometeo/2017/173 Excellence Group, Generalitat Valenciana, Valencia, Spain.,Alicante-Sant Joan Health District, Alicante, Spain
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18
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Patidar P, Mathur A, Pathak A. Can use of pictograms reduce liquid medication administration errors by mothers? An interventional study. BMC Psychol 2021; 9:99. [PMID: 34172090 PMCID: PMC8228905 DOI: 10.1186/s40359-021-00584-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 05/10/2021] [Indexed: 11/26/2022] Open
Abstract
Background Liquid medication dosing errors (LMDE) made by caregivers affect treatment in children, but this is not a well-studied topic in many low-and middle-income countries including in India. Methods An intervention study was conducted among mothers attending a pediatric outpatient clinic of a tertiary care setting in Ujjain, India. The mothers randomly measured 12 volumes of a paracetamol liquid preparation by using a dropper (0.5 and 1 mL), measuring cup (2.5 and 5 mL), and calibrated spoon (2.5 and 5 mL) each with two instructions—oral-only measurement session (OMS) and oral plus pictogram measurement session (OPMS, the intervention). The main outcome was dosing error prevalence. The effectiveness of the intervention was assessed by measuring effect size. Risk factors for maximum LMDE were explored using backward multivariate logistic regression models. A P value of < 0.05 was considered statistically significant. Results In total, 310 mothers [mean (± SD) age, 30.2 (± 4.18) years] were included. LMDE prevalence in the OMS versus OPMS for dropper 0.5 mL was 60% versus 48%; for l mL dropper was 63% versus 54%; for 2.5 mL cup 62% versus 54%; for 2.5 calibrated spoon 66% versus 59%; 5 mL cup 69% versus 57%; and 5 mL calibrated spoon 68% versus 55%. Comparing OMS with OPMS, underdosing was minimum with the calibrated spoon for 2.5 mL (OR 4.39) and maximum with the dropper for 1 mL (OR 9.40), and overdosing was minimum with the dropper for 0.5 mL (OR 7.12) and maximum with the calibrated spoon for 2.5 mL (OR 13.24). The effect size (dCohen) of the intervention OPMS was 1.86–6.4. Risk factors for the most prevalent dosing error, that is, with the calibrated spoon for 2.5 mL, were increasing age of the mother (aOR 1.08; P = 0.026) and nuclear family (aOR 2.83; P = 0.002). The risk of dosing errors decreased with higher education of the mothers. Conclusions Pictograms can effectively minimize LMDE even in less educated mothers. Supplementary Information The online version contains supplementary material available at 10.1186/s40359-021-00584-9.
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Affiliation(s)
- Pawan Patidar
- Department of Paediatrics, Ruxmaniben Deepchand Gardi Medical College, Ujjain, Madhya Pradesh, 456010, India
| | - Aditya Mathur
- Department of Paediatrics, Ruxmaniben Deepchand Gardi Medical College, Ujjain, Madhya Pradesh, 456010, India
| | - Ashish Pathak
- Department of Paediatrics, Ruxmaniben Deepchand Gardi Medical College, Ujjain, Madhya Pradesh, 456010, India. .,Department of Women and Children's Health, International Maternal and Child Health Unit, Uppsala University, Uppsala, Sweden. .,Department of Global Public Health, Health Systems and Policy: Medicines Focusing Antibiotics, Karolinska Institutet, Stockholm, Sweden.
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19
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Yu KE, Kim JS. Pediatric Postoperative Pain Management in Korea: Parental Attitudes Toward Pain and Analgesics, Self-Efficacy, and Pain Management. J Pediatr Nurs 2021; 58:e28-e36. [PMID: 33358485 DOI: 10.1016/j.pedn.2020.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 12/03/2020] [Accepted: 12/03/2020] [Indexed: 11/29/2022]
Abstract
PURPOSES This study aimed to explore parental attitudes toward children's pain and analgesic drugs and parental self-efficacy and use of pain relief strategies in children's postoperative pain management in Korea, and to identify the relationships among these variables. DESIGN AND METHODS A cross sectional descriptive study was conducted. Participants were 124 parents of hospitalized children (aged 4-9 years) undergoing tonsillectomy in Korea. RESULTS A considerable proportion of parents held misconceptions about how children express pain. For example, 87.9% of parents perceived that children always tell their parents when they are in pain. Moreover, parents reported significant attitudinal barriers to analgesic use with 60.5% of parents believed that side effects are something to worry about when giving children pain medication. Parental attitudes to use analgesics were significantly different by children's gender, family income, and length of hospital stay. Emotional support methods such as touch, parental presence, and comfort/reassurance were the frequently used, whereas cognitive-behavioral approaches such as distraction were less frequently used nonpharmacological pain relief strategies. A parent's self-efficacy in managing children's pain significantly correlated with the appropriate use of analgesics and parental use of pain relief strategies. CONCLUSIONS Promoting parental self-efficacy in postoperative pain management is important. Educational interventions focused on behavioral changes of parents, including practical guidance for pharmacological and nonpharmacological pain relief strategies, are needed. PRACTICE IMPLICATIONS Providing parents with proper, effective education about children's postoperative pain management should not only provide accurate information but should also enhance parents' self-efficacy in assessing and managing children's pain.
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Affiliation(s)
- Kyoung Eun Yu
- Department of Nursing, Donggang University, South Korea
| | - Jin Sun Kim
- Department of Nursing, Chosun University, South Korea.
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20
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NCPDP recommendations for standardizing dosing in metric units (mL) on prescription container labels of oral liquid medications, version 2.0. Am J Health Syst Pharm 2021; 78:578-605. [PMID: 33647100 PMCID: PMC7970405 DOI: 10.1093/ajhp/zxab023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Best practices and guidance are provided for standardizing dosing instructions on prescription container labels of oral liquid medications by eliminating use of U.S. customary (household) units and adopting metric units universally, with the goal of decreasing the potential for error and improving safety and outcomes when patients and caregivers take and administer these medications. SUMMARY Despite decades of best practice use of metric units in organized healthcare settings and advocacy by various professional societies, medication safety experts, and standards setting organizations, use of household units (e.g., teaspoon) on prescription container labeling instructions for oral liquid medications persists in community pharmacy settings. Five years after publication of the National Council for Prescription Drug Programs' (NCPDP's) original white paper advocating metric-only dosing, very few community pharmacy companies appear to require oral liquid dosing instructions be presented in metric-only units (mL). Error-prone dosing designations contribute to medication errors and patient harm. Use of both multiple volumetric units (e.g., teaspoonsful, tablespoonsful) and multiple abbreviations for the same volumetric units (e.g., mL, cc, mls; tsp, TSP, t) increases the likelihood of dosing errors. Opportunities for error exist with each administration of an oral liquid medication and, unless coordinated with dispensing of appropriate oral dosing devices and optimal counseling, can result in use of household utensils (e.g., uncalibrated teaspoons) or discordantly marked devices that can further exacerbate the risk of error. Since publication of NCPDP's original white paper, new standards have been adopted governing official liquid volume representation, calibrated dosing devices, and e-prescribing software which support the elimination of non-metric units to reduce use of dosing practices that are error-prone. In each case, U.S. customary (household) units have been eliminated in official standards and certification requirements. Therefore, use of non-metric units for oral dosing of liquid medications no longer is an acceptable practice. CONCLUSION Key factors contributing to dosing errors with oral liquid medications include use of multiple volumetric units and abbreviations; failure to institute policies and procedures that eliminate the use of non-metric (e.g., household) units and universally adopt metric-only dosing instructions in all settings; failure to coordinate dosing instructions with dosing device markings, appropriate type (oral syringe versus cup), and optimal volumes (e.g., 1-, 5-, or 10-mL devices); failure to adequately counsel patients about appropriate measurement and administration of oral liquid medication doses; and use or error-prone practices such as missing leading zeros and elimination of trailing zeros in prescriptions and container labels. Adoption of this white paper's recommendations will align dosing designations for oral liquid medications in all settings with current standards and attain universal metric-only practice.
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21
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Blackmer AB, Fox D, Arendt D, Phillips K, Feinstein JA. Perceived Versus Demonstrated Understanding of the Complex Medications of Medically Complex Children. J Pediatr Pharmacol Ther 2021; 26:62-72. [PMID: 33424502 DOI: 10.5863/1551-6776-26.1.62] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 06/10/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Parents and caregivers of children with medical complexity (CMC) manage complex medication regimens (CMRs) at home. Parental understanding of CMRs is critical to safe medication administration. Regarding CMR administration, we 1) described the population of CMC receiving CMRs; 2) assessed parental perceived confidence and understanding; and 3) evaluated parental demonstrated understanding. METHODS Cross-sectional clinic-based assessment of knowledge and understanding of CMC using CMRs who received primary care in a large pediatric complex care clinic. CMRs were identified by the receipt of ≥1 of the following: 1) ≥10 concurrent medications; 2) ≥1 high-risk medication; or 3) ≥1 extemporaneously compounded medication. Parents reported their perceived confidence and understanding of CMRs, and then demonstrated understanding through 3 medication-related tasks. RESULTS Of 156 CMCs, most were <10 years of age (63.5%), white (75%), had neurologic impairment (76.9%), and used a median of 8 medications (IQR, 5-10). Parents were female (76.9%) with a mean age of 38.8 ± 11.5 years, white (69.9%), spoke English (94.2%), and had some college education (82.1%). On 11 confidence and understanding statements, most parents reported a high perceived level of understanding and confidence, with combined agreement or strong agreement ranging between 81.2% and 98.7%. Only 73.1% correctly identified medications taken for specified conditions, 40.4% reported complete dosing parameters, and 54.8% correctly measured 2 different medication doses. Significant differences existed between parental perceived understanding versus the 3 demonstrated tasks (all p < 0.05). CONCLUSIONS Substantial opportunities exist to improve medication safety and efficacy in the outpatient, in-home setting including improved medication-specific education and medication-related supports.
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22
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Naureckas Li C, Camargo CA, Faridi M, Espinola JA, Hayes BD, Porter S, Cohen A, Samuels-Kalow M. Medication Education for Dosing Safety: A Randomized Controlled Trial. Ann Emerg Med 2020; 76:637-645. [PMID: 32807539 DOI: 10.1016/j.annemergmed.2020.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 05/01/2020] [Accepted: 05/08/2020] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVE This study sought to determine whether a brief intervention at the time of emergency department (ED) discharge can improve safe dosing of liquid acetaminophen and ibuprofen by parents or guardians. METHODS We performed a randomized controlled trial in the ED of parents and guardians of children 90 days to 11.9 years of age who were discharged with acetaminophen or ibuprofen, or both. Families were randomized to standard care or a teaching intervention combining lay language, simplified handouts, provision of an unmarked dosing syringe, and teach-back to confirm correct dosing. Participants were called 48 to 72 hours and 5 to 7 days after ED discharge to assess understanding of correct dosing. The primary outcome was defined as parent or guardian report of safe dosing at the time of first follow-up call. Our primary hypothesis was that the intervention would decrease the rate of error from 30% to 10% at 48- to 72-hour follow-up. RESULTS We enrolled 149 of 259 (58%) eligible subjects; 97 of 149 (65%) were reached at first follow-up call, of whom 35 of 97 (36%) received the intervention. Among those participants receiving the intervention, 25 of 35 (71%) were able to identify a safe dose for their child at the time of the first call compared with 28 of 62 (45%) of those in the control arm. The difference in proportions was 26% (95% confidence interval [CI] 7% to 46%). There was a 58% increase in reporting safe dosing in the intervention group compared with the control roup (relative risk 1.58; 95% CI 1.12 to 2.24), and it remained significant after adjustment for health literacy and language (adjusted relative risk 1.50; 95% CI 1.06 to 2.13). CONCLUSIONS A multifaceted intervention at the time of ED discharge-consisting of a simplified dosing handout, a teaching session, teach-back, and provision of a standardized dosing device-can improve parents' knowledge of safe dosing of liquid medications at 48 to 72 hours.
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Affiliation(s)
- Caitlin Naureckas Li
- Division of Pediatric Infectious Diseases, Boston Children's Hospital, Boston, MA.
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Mohammad Faridi
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Janice A Espinola
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Bryan D Hayes
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA; Department of Pharmacy, Massachusetts General Hospital, Boston, MA
| | - Stephen Porter
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Division of Emergency Medicine, Cincinnati Children's Hospital, Cincinnati, OH
| | - Ari Cohen
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
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23
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Budnitz DS, Lovegrove MC, Geller RJ. Prevention of Unintentional Medication Overdose Among Children: Time for the Promise of the Poison Prevention Packaging Act to Come to Fruition. JAMA 2020; 324:550-551. [PMID: 32722746 DOI: 10.1001/jama.2020.2152] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Daniel S Budnitz
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Maribeth C Lovegrove
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Robert J Geller
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
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24
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Nguyen TT, Bergeron E, Lewis TV, Miller JL, Hagemann TM, Neely S, Johnson PN. Descriptive study of discharge medications in pediatric patients. SAGE Open Med 2020; 8:2050312120927945. [PMID: 32547752 PMCID: PMC7271562 DOI: 10.1177/2050312120927945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 04/27/2020] [Indexed: 11/24/2022] Open
Abstract
Background: Limited studies have evaluated medications in children discharged from
hospitals. Knowledge of the number of medications and dosage forms could
provide a baseline to establish a medication discharge prescription
program. Objectives: To identify the median number of discharge prescriptions per patient.
Secondary objectives included an evaluation of the dosage formulations and
frequency, and comparisons of the prevalence of unrounded medication doses
between service type (medical vs surgical) and physician provider level
(trainees vs attendings). Methods: This retrospective study included children <18 years receiving
>1 discharge prescription during 4 selected
months over a 1-year time frame. Comparisons were made via Pearson’s
chi-square tests, Fisher’s Exact tests, and Kruskal–Wallis nonparametric
rank tests as appropriate with a priori p value of
<0.05. Results: A total of 852 patients were evaluated, with most (78.8%) on a medical
service. The median (interquartile range) number of new medications at
discharge was 2 (1–3), with the median total number of discharge medications
of 3 (2–6). There was no difference in the net change of the median number
of home medications stopped and new medications started between service
types. The majority (72.2%) received >1 oral
liquid medications. There was no difference in prescribing rates per service
type and provider level. There was a difference in the number of unrounded
doses between trainees versus attendings, 17.8% versus 9.5%,
p = 0.048. Conclusion: Patients were discharged on a median of three medications, and most received
>1 oral liquid medications. These data can be
used to target children who would benefit from medication discharge
prescription programs.
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Affiliation(s)
- Thao T Nguyen
- The Children’s Hospital at Saint
Francis, Tulsa, OK, USA
| | - Erica Bergeron
- Department of Pharmacy: Clinical and
Administrative Sciences, The University of Oklahoma College of Pharmacy, Oklahoma
City, OK, USA
| | - Teresa V Lewis
- Department of Pharmacy: Clinical and
Administrative Sciences, The University of Oklahoma College of Pharmacy, Oklahoma
City, OK, USA
| | - Jamie L Miller
- Department of Pharmacy: Clinical and
Administrative Sciences, The University of Oklahoma College of Pharmacy, Oklahoma
City, OK, USA
| | | | - Stephen Neely
- Department of Pharmacy: Clinical and
Administrative Sciences, The University of Oklahoma College of Pharmacy, Oklahoma
City, OK, USA
| | - Peter N Johnson
- Department of Pharmacy: Clinical and
Administrative Sciences, The University of Oklahoma College of Pharmacy, Oklahoma
City, OK, USA
- Peter N Johnson, Department of Pharmacy:
Clinical and Administrative Sciences, The University of Oklahoma College of
Pharmacy, O’Donoghue Research Building, Suite ODON4415, 1122 Northeast 13th
Street, Oklahoma City, OK 73117, USA.
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25
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Davis SH, Rosenberg J, Nguyen J, Jimenez M, Lion KC, Jenicek G, Dallmann H, Yun K. Translating Discharge Instructions for Limited English-Proficient Families: Strategies and Barriers. Hosp Pediatr 2020; 9:779-787. [PMID: 31562199 DOI: 10.1542/hpeds.2019-0055] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Access to written hospital discharge instructions improves caregiver understanding and patient outcomes. However, nearly half of hospitals do not translate discharge instructions, and little is known about why. OBJECTIVES To identify barriers to and potential strategies for translating children's hospital discharge instructions. METHODS We conducted a mixed-methods, multimodal analysis. Data comprised closed- and open-ended responses to an online survey sent to Children's Hospital Association language services contacts (n = 31), an online environmental scan of Children's Hospital Association translation policies (n = 22), and county-level census data. We examined quantitative data using descriptive statistics and analyzed open-ended survey responses and written policies using inductive qualitative content analysis. RESULTS Most survey respondents (81%) reported having a written translation policy at their hospital, and all reported translating a subset of hospital documents, for example, consent forms. Most but not all reported translating discharge instructions (74%). When asked how inpatient staff typically provide translated discharge instructions, most reported use of pretranslated documents (87%) or staff interpreters (81%). Reported barriers included difficulty translating uncommon languages, mismatched discharge and translation time frames, and inconsistent clinical staff use of translation services. Strategies to address barriers included document libraries, pretranslated electronic health record templates, staff-edited machine translations, and sight translation. Institutional policies differed regarding the appropriateness of allowing interpreters to assist with translation. Respondents agreed that machine translation should not be used alone. CONCLUSIONS Children's hospitals experience similar operational and organizational barriers in providing language-concordant discharge instructions. Current strategies focus on translating standardized documents; collaboration and innovation may encourage provision of personalized documents.
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Affiliation(s)
- Seethalakshmi H Davis
- Swarthmore College, Swarthmore, Pennsylvania; .,PolicyLab, Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Julia Rosenberg
- Department of Pediatrics, Yale New Haven Children's Hospital, New Haven, Connecticut.,National Clinician Scholars Program, Yale University, New Haven, Connecticut
| | - Jenny Nguyen
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Manuel Jimenez
- Department of Pediatrics, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - K Casey Lion
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington.,Department of Pediatrics, University of Washington School of Medicine, University of Washington, Seattle, Washington; and
| | - Gabriela Jenicek
- PolicyLab, Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Harry Dallmann
- Department of Pediatrics, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Katherine Yun
- PolicyLab, Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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26
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Dahmash DT, Shariff ZB, Kirby DJ, Terry D, Huynh C. Literature review of medication administration problems in paediatrics by parent/caregiver and the role of health literacy. BMJ Paediatr Open 2020; 4:e000841. [PMID: 33305018 PMCID: PMC7692990 DOI: 10.1136/bmjpo-2020-000841] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/09/2020] [Accepted: 11/09/2020] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To identify studies that highlighted medication administration problems experienced by parents and children, which also looked at health literacy aspect using a validated tool to assess for literacy. STUDY DESIGN Ten electronic databases were systematically searched and supplemented by hand searching through reference lists using the following search terms: (1) paediatric, (2) medication error including dosing error, medication administration error, medication safety and medication optimisation and (3) health literacy. RESULTS Of the (1230) records screened, 14 studies were eligible for inclusion. Three analytical themes emerged from the synthesis. The review highlighted that frequencies and magnitudes of dosing errors vary by the measurement tools used, the dose prescribed and by the administration instruction provided. Parent's sociodemographic, such as health literacy and language, is a key factor to be considered when designing an intervention aimed at averting medication administration errors at home. The review summarised some potential strategies that could help in reducing medication administration errors among children at home. Among these recommendations is to show the prescribed dose to the parents or young people along with the verbal instructions, as well as to match the prescribed dose with the measuring tool dispensed, to provide an explicit dose intervals and pictographic dosing instructions. CONCLUSION The findings suggest that in order to optimise medication use by parents, further work is needed to address the nature of these issues at home. Counselling, medication administration instructions and measurement tools are some of the areas in addition to the sociodemographic characteristics of parents and young people that need to be considered when designing any future potential intervention aimed at reducing medication errors among children and young people at home.
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Affiliation(s)
- Dania Talaat Dahmash
- Aston Pharmacy School, College of Health and Life Sciences, Aston University, Birmingham, United Kingdom
| | - Zakia B Shariff
- Aston Pharmacy School, College of Health and Life Sciences, Aston University, Birmingham, United Kingdom
| | - Daniel J Kirby
- Aston Pharmacy School, College of Health and Life Sciences, Aston University, Birmingham, United Kingdom
| | - David Terry
- Aston Pharmacy School, College of Health and Life Sciences, Aston University, Birmingham, United Kingdom
| | - Chi Huynh
- Aston Pharmacy School, College of Health and Life Sciences, Aston University, Birmingham, United Kingdom
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27
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Williams TA, Wolf MS, Parker RM, Sanders LM, Bailey S, Mendelsohn AL, Dreyer BP, Velazquez JJ, Yin HS. Parent Dosing Tool Use, Beliefs, and Access: A Health Literacy Perspective. J Pediatr 2019; 215:244-251.e1. [PMID: 31604631 PMCID: PMC6963991 DOI: 10.1016/j.jpeds.2019.08.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/08/2019] [Accepted: 08/07/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To assess parent decision-making regarding dosing tools, a known contributor to medication dosing errors, by evaluating parent dosing tool use, beliefs, and access, and the role of health literacy, with a focus on dosing cups, which are associated with an increased risk of multifold overdose. STUDY DESIGN Cross-sectional analysis of data collected for randomized controlled study in 3 urban pediatric clinics. English/Spanish-speaking parents (n = 493) of children ≤8 years of age enrolled. OUTCOMES reported tool use, beliefs, and access. Predictor variable: health literacy (Newest Vital Sign; limited [0-3], adequate [4-6]). Multiple logistic regression analyses conducted. RESULTS Over two-thirds of parents had limited health literacy. Oral syringes (62%) and dosing cups (22%) were most commonly used. Overall, 24% believed dosing cups were the best tool type for dosing accuracy; 99% reported having access to ≥1 dosing tools with standard measurement markings. Parents with limited health literacy had greater odds of dosing cup use (limited vs adequate: aOR = 2.4 [1.2-4.6]). Parents who believed that dosing cups are best for accuracy had greater odds of dosing cup use (aOR = 16.3 [9.0-29.3]); this belief mediated health literacy-effects on dosing cup use. CONCLUSIONS Factors associated with dosing tool choice, including parent health literacy and beliefs are important to consider in the design of interventions to reduce dosing errors; future larger-scale studies addressing this issue are needed.
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Affiliation(s)
| | - Michael S. Wolf
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Ruth M. Parker
- Medicine, Emory University School of Medicine, Atlanta, GA
| | - Lee M. Sanders
- Pediatrics, Stanford University School of Medicine, Palo Alto, CA
| | - Stacy Bailey
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Alan L. Mendelsohn
- Pediatrics, NYU School of Medicine - Bellevue Hospital, New York, NY,Population Health, NYU School of Medicine, New York, NY
| | - Benard P. Dreyer
- Pediatrics, NYU School of Medicine - Bellevue Hospital, New York, NY
| | | | - H. Shonna Yin
- Pediatrics, NYU School of Medicine - Bellevue Hospital, New York, NY,Population Health, NYU School of Medicine, New York, NY
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28
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Philips K, Zhou R, Lee DS, Marrese C, Nazif J, Browne C, Sinnett M, Tuckman S, Griffith K, Kiely V, Lutz M, Modi A, Rinke ML. Caregiver Medication Management and Understanding After Pediatric Hospital Discharge. Hosp Pediatr 2019; 9:844-850. [PMID: 31582401 PMCID: PMC6818354 DOI: 10.1542/hpeds.2019-0036] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Caregivers frequently make mistakes when following instructions on discharge medications, and these instructions often contain discrepancies. Minimal literature reflects inpatient discharges. Our objective was to describe failures in caregiver management and understanding of inpatient discharge medications and to test the association of documentation discrepancies and sociodemographic factors with medication-related failures after an inpatient hospitalization. METHODS This study took place in an urban tertiary care children's hospital that serves a low-income, minority population. English-speaking caregivers of children discharged on an oral prescription medication were surveyed about discharge medication knowledge 48 to 96 hours after discharge. The primary outcome was the proportion of caregivers who failed questions on a 10-item questionnaire (analyzed as individual question responses and as a composite outcome of any discharge medication-related failure). Bivariate tests were used to compare documentation errors, complex dosing, and sociodemographic factors to having any discharge medication-related failure. RESULTS Of 157 caregivers surveyed, 70% had a discharge medication-related failure, most commonly because of lack of knowledge about side effects (52%), wrong duration (17%), and wrong start time (16%). Additionally, 80% of discharge instructions provided to caregivers lacked integral medication information, such as duration or when the next dose after discharge was due. Twenty five percent of prescriptions contained numerically complex doses. In bivariate testing, only race and/or ethnicity was significantly associated with having any failure (P = .03). CONCLUSIONS The majority of caregivers had a medication-related failure after discharge, and most discharge instructions lacked key medication information. Future work to optimize the discharge process to support caregiver management and understanding of medications is needed.
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Affiliation(s)
- Kaitlyn Philips
- Children's Hospital at Montefiore, Bronx, New York;
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York; and
| | - Roy Zhou
- Children's Hospital at Montefiore, Bronx, New York
| | - Diana S Lee
- Children's Hospital at Montefiore, Bronx, New York
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York; and
| | | | - Joanne Nazif
- Children's Hospital at Montefiore, Bronx, New York
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York; and
| | | | - Mark Sinnett
- Children's Hospital at Montefiore, Bronx, New York
| | | | | | | | - Marcia Lutz
- Children's Hospital at Montefiore, Bronx, New York
| | - Anjali Modi
- Children's Hospital at Montefiore, Bronx, New York
| | - Michael L Rinke
- Children's Hospital at Montefiore, Bronx, New York
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York; and
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29
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Glick AF, Farkas JS, Mendelsohn AL, Fierman AH, Tomopoulos S, Rosenberg RE, Dreyer BP, Melgar J, Varriano J, Yin HS. Discharge Instruction Comprehension and Adherence Errors: Interrelationship Between Plan Complexity and Parent Health Literacy. J Pediatr 2019; 214:193-200.e3. [PMID: 31253406 PMCID: PMC10866623 DOI: 10.1016/j.jpeds.2019.04.052] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 03/12/2019] [Accepted: 04/25/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To examine associations between parent health literacy, discharge plan complexity, and parent comprehension of and adherence to inpatient discharge instructions. STUDY DESIGN This was a prospective cohort study of English/Spanish-speaking parents (n = 165) of children ≤12 years discharged on ≥1 daily medication from an urban, public hospital. Outcome variables were parent comprehension (survey) of and adherence (survey, in-person dosing assessment, chart review) to discharge instructions. Predictor variables included low parent health literacy (Newest Vital Sign score 0-3) and plan complexity. Generalized estimating equations were used to account for the assessment of multiple types of comprehension and adherence errors for each subject, adjusting for ethnicity, language, child age, length of stay, and chronic disease status. Similar analyses were performed to assess for mediation and moderation. RESULTS Error rates were highest for comprehension of medication side effects (50%), adherence to medication dose (34%), and return precaution (78%) instructions. Comprehension errors were associated with adherence errors (aOR, 8.7; 95% CI, 5.9-12.9). Discharge plan complexity was associated with comprehension (aOR, 7.0; 95% CI, 5.4-9.1) and adherence (aOR, 5.5; 95% CI, 4.0-7.6) errors. Low health literacy was indirectly associated with adherence errors through comprehension errors. The association between plan complexity and comprehension errors was greater in parents with low (aOR, 8.3; 95% CI, 6.2-11.2) compared with adequate (aOR, 3.8; 95% CI, 2.2-6.5) health literacy (interaction term P = .004). CONCLUSIONS Parent health literacy and discharge plan complexity play key roles in comprehension and adherence errors. Future work will focus on the development of health literacy-informed interventions to promote discharge plan comprehension.
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Affiliation(s)
- Alexander F Glick
- New York University School of Medicine/NYU Langone Health, New York, NY; Bellevue Hospital Center, New York, NY.
| | - Jonathan S Farkas
- New York University School of Medicine/NYU Langone Health, New York, NY; Bellevue Hospital Center, New York, NY
| | - Alan L Mendelsohn
- New York University School of Medicine/NYU Langone Health, New York, NY; Bellevue Hospital Center, New York, NY
| | - Arthur H Fierman
- New York University School of Medicine/NYU Langone Health, New York, NY; Bellevue Hospital Center, New York, NY
| | - Suzy Tomopoulos
- New York University School of Medicine/NYU Langone Health, New York, NY; Bellevue Hospital Center, New York, NY
| | - Rebecca E Rosenberg
- New York University School of Medicine/NYU Langone Health, New York, NY; Bellevue Hospital Center, New York, NY
| | - Benard P Dreyer
- New York University School of Medicine/NYU Langone Health, New York, NY; Bellevue Hospital Center, New York, NY
| | - Jennifer Melgar
- New York University School of Medicine/NYU Langone Health, New York, NY; Bellevue Hospital Center, New York, NY
| | - John Varriano
- New York University School of Medicine/NYU Langone Health, New York, NY; Bellevue Hospital Center, New York, NY
| | - H Shonna Yin
- New York University School of Medicine/NYU Langone Health, New York, NY; Bellevue Hospital Center, New York, NY
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30
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Platter E, Hamline MY, Tancredi DJ, Fernandez Y Garcia E, Rosenthal JL. Completeness of Written Discharge Guidance for English- and Spanish-Speaking Patient Families. Hosp Pediatr 2019; 9:516-522. [PMID: 31182648 DOI: 10.1542/hpeds.2018-0250] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Written discharge guidance for hospitalized pediatric patients should include language-appropriate key elements to ensure positive discharge outcomes. Our objective in this study was to determine the completeness of written pediatric discharge guidance and to test the hypothesis that Spanish-speaking families with limited English proficiency (LEP) receive less complete written discharge guidance than English-speaking families. METHODS We conducted a retrospective review of written discharge guidance provided to 100 English- and 100 Spanish-speaking families at an urban nonfreestanding children's hospital to assess the inclusion of key elements: follow-up plan, contingency plan, telephone contact, discharge medications, discharge diagnosis, and hospital course. We compared the completeness of discharge guidance (number of elements provided among number of applicable elements) between English- versus Spanish-speaking families. RESULTS When evaluating discharge guidance for the presence of key elements in any language, there was no significant difference between English- and Spanish-speaking families. However, the mean completeness of language-appropriate discharge guidance for English- and Spanish-speaking families was 87.8% (95% confidence interval [CI] 84.4%-91.1%) and 16.0% (95% CI 11.5%-20.4%), respectively. The ordinal logistic regression examining the association between the number of key element deficits and English- (reference group) versus Spanish-speaking families demonstrated an adjusted odds ratio of 339.8 (95% CI 112.4-1027.5). CONCLUSIONS Few Spanish-speaking families with LEP receive written discharge guidance in their preferred language. Complete, language-appropriate discharge guidance was identified as an area for improvement efforts to work toward improving care provided to families with LEP.
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Affiliation(s)
- Erin Platter
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia; and
| | - Michelle Y Hamline
- Department of Pediatrics, University of California, Davis, Sacramento, California
| | - Daniel J Tancredi
- Department of Pediatrics, University of California, Davis, Sacramento, California
| | | | - Jennifer L Rosenthal
- Department of Pediatrics, University of California, Davis, Sacramento, California
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31
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Interventions to assist parents and caregivers in accurately dosing liquid medications for their children: a scoping review. DRUGS & THERAPY PERSPECTIVES 2019. [DOI: 10.1007/s40267-019-00615-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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32
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Mueller BU, Neuspiel DR, Fisher ERS, Franklin W, Adirim T, Bundy DG, Ferguson LE, Gleeson SP, Leu M, Quinonez RA, Rinke ML, Shiffman RN, Saarel EV, Tieder JS, Yin HS, Phillips SC, Quinonez R, Brown JM, Walsh KM, Jewell J, Ernst K, Hill VL, Lam V, Vinocur C, Rauch D, Hsu B. Principles of Pediatric Patient Safety: Reducing Harm Due to Medical Care. Pediatrics 2019; 143:peds.2018-3649. [PMID: 30670581 DOI: 10.1542/peds.2018-3649] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Pediatricians render care in an increasingly complex environment, which results in multiple opportunities to cause unintended harm. National awareness of patient safety risks has grown since the National Academy of Medicine (formerly the Institute of Medicine) published its report "To Err Is Human: Building a Safer Health System" in 1999. Patients and society as a whole continue to challenge health care providers to examine their practices and implement safety solutions. The depth and breadth of harm incurred by the practice of medicine is still being defined as reports continue to reveal a variety of avoidable errors, from those that involve specific high-risk medications to those that are more generalizable, such as patient misidentification and diagnostic error. Pediatric health care providers in all practice environments benefit from having a working knowledge of patient safety language. Pediatric providers should serve as advocates for best practices and policies with the goal of attending to risks that are unique to children, identifying and supporting a culture of safety, and leading efforts to eliminate avoidable harm in any setting in which medical care is rendered to children. In this Policy Statement, we provide an update to the 2011 Policy Statement "Principles of Pediatric Patient Safety: Reducing Harm Due to Medical Care."
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Affiliation(s)
- Brigitta U. Mueller
- Johns Hopkins All Children’s Hospital, St Petersburg, Florida
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | - Erin R. Stucky Fisher
- Department of Pediatrics, University of California San Diego and Rady Children’s Hospital San Diego, San Diego, California
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33
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Benjamin L, Frush K, Shaw K, Shook JE, Snow SK. Pediatric Medication Safety in the Emergency Department. Ann Emerg Med 2018; 71:e17-e24. [PMID: 29458814 DOI: 10.1016/j.annemergmed.2017.12.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Indexed: 12/21/2022]
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34
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Brass EP, Reynolds KM, Burnham RI, Green JL. Medication Errors With Pediatric Liquid Acetaminophen After Standardization of Concentration and Packaging Improvements. Acad Pediatr 2018. [PMID: 29522886 DOI: 10.1016/j.acap.2018.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the impact of the 2011 changes in pediatric single-ingredient liquid acetaminophen product packaging and standardization of the acetaminophen concentration (160 mg/5 mL) on poison control center exposures due to medication errors. METHODS National Poison Data System (NPDS) data from January 1, 2007, through December 31, 2016, were used to identify medication error exposures involving single-ingredient liquid acetaminophen in children younger than 12 years of age. Surveys were conducted through 6 regional poison control centers to obtain additional information on a subset of exposures. RESULTS The annual frequency of NPDS exposures due to medication errors with single-ingredient liquid acetaminophen products was 8260 ± 670 exposures/year during 2007-2011. Children <2 years of age accounted for 66% of exposures. The overall rate of exposures fell to 6669 ± 662 during 2012-2016 (19% decrease; P = .005). Four percent of exposures led to health care facility referrals. Caregivers involved with exposures in children <2 years of age cited health professionals as the source of dosing information in only 69% of cases despite the absence of specific dosing directions for these children on product labels. CONCLUSIONS Implementation of a single concentration for pediatric liquid acetaminophen products and packaging changes were associated with a decrease in medication errors reported to poison control centers. Medication errors are particularly problematic for children <2 years of age, for whom there are no specific labeled dosing instructions. Improved efforts to provide caregivers with dosing instructions for these children are encouraged.
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Affiliation(s)
- Eric P Brass
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, Palos Verdes, Calif
| | - Kate M Reynolds
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, Colo.
| | - Randy I Burnham
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, Colo
| | - Jody L Green
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, Colo
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35
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Risk of poisoning in children and adolescents with ADHD: a systematic review and meta-analysis. Sci Rep 2018; 8:7584. [PMID: 29765117 PMCID: PMC5953942 DOI: 10.1038/s41598-018-25893-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 05/01/2018] [Indexed: 12/26/2022] Open
Abstract
Poisoning, a subtype of physical injury, is an important hazard in children and youth. Individuals with ADHD may be at higher risk of poisoning. Here, we conducted a systematic review and meta-analysis to quantify this risk. Furthermore, since physical injuries, likely share causal mechanisms with those of poisoning, we compared the relative risk of poisoning and injuries pooling studies reporting both. As per our pre-registered protocol (PROSPERO ID CRD42017079911), we searched 114 databases through November 2017. From a pool of 826 potentially relevant references, screened independently by two researchers, nine studies (84,756 individuals with and 1,398,946 without the disorder) were retained. We pooled hazard and odds ratios using Robust Variance Estimation, a meta-analytic method aimed to deal with non-independence of outcomes. We found that ADHD is associated with a significantly higher risk of poisoning (Relative Risk = 3.14, 95% Confidence Interval = 2.23 to 4.42). Results also indicated that the relative risk of poisoning is significantly higher than that of physical injuries when comparing individuals with and without ADHD (Beta coefficient = 0.686, 95% Confidence Interval = 0.166 to 1.206). These findings should inform clinical guidelines and public health programs aimed to reduce physical risks in children/adolescents with ADHD.
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36
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Lovegrove MC, Sapiano MRP, Paul IM, Yin HS, Wilkins TL, Budnitz DS. Primary Care Provider Perceptions and Practices Regarding Dosing Units for Oral Liquid Medications. Acad Pediatr 2018; 18:405-408. [PMID: 29269029 PMCID: PMC6714557 DOI: 10.1016/j.acap.2017.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 12/07/2017] [Accepted: 12/10/2017] [Indexed: 11/21/2022]
Abstract
INTRODUCTION To prevent errors, health care professional and safety organizations recommend using milliliters (mL) alone for oral liquid medication dosing instructions and devices. In 2018, for federal incentives under the Quality Payment Program, one requirement is for electronic health records to automatically use mL alone whenever oral liquid medications are prescribed. Current perceptions and practices of primary care providers (PCPs) regarding dosing units for oral liquid medications were assessed. METHODS Pediatricians, family practitioners, nurse practitioners, and internists participating in the 2015 DocStyles Web-based survey were asked about their perceptions and practices regarding dosing units for oral liquid medications. RESULTS Three fifths of PCPs (59.0%) reported that using mL alone is safest for dosing oral liquid medications; however, nearly three quarters (72.0%) thought that patients/caregivers prefer instructions that include spoon-based units. Within each specialty, fewer PCPs reported they would prescribe using mL alone than reported that using mL alone is safest (P < .0001 for all). Among PCPs who think milliliter-only dosing is safest, those who perceived patients/caregivers prefer including spoon-based units were less likely to prescribe using mL alone (odds ratio 0.45, 95% confidence interval 0.34-0.59). Pediatricians were more likely than other PCPs to report that it is safest to use mL alone (80.8% vs 54.7%) and that they would use mL alone when prescribing (56.8% vs 30.9%) (P < .0001 for both). CONCLUSIONS Because less than two thirds of pediatricians and one third of other PCPs would use mL alone in dosing instructions, additional education to encourage prescribing and communicating with patients/caregivers using mL alone may be needed.
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Affiliation(s)
- Maribeth C Lovegrove
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Ga.
| | - Mathew R P Sapiano
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Ga
| | - Ian M Paul
- Department of Pediatrics, Penn State College of Medicine, Hershey, Pa
| | - H Shonna Yin
- Departments of Pediatrics and Population Health, New York University School of Medicine, New York, NY
| | - Tricia Lee Wilkins
- Office of the National Coordinator for Health Information Technology, Office of Standards and Technology, Washington, DC; Department of Pharmacy Affairs, Academy of Managed Care Pharmacy, Alexandria, Va
| | - Daniel S Budnitz
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Ga
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Benjamin L, Frush K, Shaw K, Shook JE, Snow SK, Wright J, Adirim T, Agus MS, Callahan J, Gross T, Lane N, Lee L, Mazor S, Mahajan P, Timm N, Joseph M, Alade K, Amato C, Avarello JT, Baldwin S, Barata IA, Berg K, Brown K, Bullard-Berent J, Dietrich AM, Friesen P, Gerardi M, Heins A, Holtzman DK, Homme J, Horeczko T, Ishimine P, Lam S, Long K, Mayz K, Mehta S, Mellick L, Ojo A, Paul AZ, Pauze DR, Pearson NM, Perina D, Petrack E, Rayburn D, Rose E, Russell WS, Ruttan T, Saidinejad M, Sanders B, Simpson J, Solari P, Stoner M, Valente JH, Wall J, Wallin D, Waseem M, Whiteman PJ, Woolridge D, Young T, Foresman-Capuzzi J, Johnson R, Martin H, Milici J, Brandt C, Nelson N. Pediatric Medication Safety in the Emergency Department. Pediatrics 2018; 141:peds.2017-4066. [PMID: 30352389 DOI: 10.1542/peds.2017-4066] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Pediatric patients cared for in emergency departments (EDs) are at high risk of medication errors for a variety of reasons. A multidisciplinary panel was convened by the Emergency Medical Services for Children program and the American Academy of Pediatrics Committee on Pediatric Emergency Medicine to initiate a discussion on medication safety in the ED. Top opportunities identified to improve medication safety include using kilogram-only weight-based dosing, optimizing computerized physician order entry by using clinical decision support, developing a standard formulary for pediatric patients while limiting variability of medication concentrations, using pharmacist support within EDs, enhancing training of medical professionals, systematizing the dispensing and administration of medications within the ED, and addressing challenges for home medication administration before discharge.
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Affiliation(s)
- Lee Benjamin
- Department of Emergency Medicine, St Joseph Mercy Ann Arbor, Ypsilanti, Michigan
| | - Karen Frush
- Department of Pediatrics, School of Medicine, Duke University, Durham, North Carolina
| | - Kathy Shaw
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Joan E. Shook
- Section of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas; and
| | - Sally K. Snow
- Retired; Former Trauma Program Director, Cook Children's Medical Center, Fort Worth, Texas
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Walsh J, Ranmal SR, Ernest TB, Liu F. Patient acceptability, safety and access: A balancing act for selecting age-appropriate oral dosage forms for paediatric and geriatric populations. Int J Pharm 2018; 536:547-562. [DOI: 10.1016/j.ijpharm.2017.07.017] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 07/06/2017] [Accepted: 07/07/2017] [Indexed: 11/30/2022]
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Torres A, Parker RM, Sanders LM, Wolf MS, Bailey SC, Patel DA, Jimenez JJ, Kim KYA, Dreyer BP, Mendelsohn AL, Yin HS. Parent Preferences and Perceptions of Milliliters and Teaspoons: Role of Health Literacy and Experience. Acad Pediatr 2018; 18:26-34. [PMID: 28400304 PMCID: PMC5632573 DOI: 10.1016/j.acap.2017.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 03/28/2017] [Accepted: 04/01/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVES A recent American Academy of Pediatrics policy statement recommends milliliter-exclusive dosing for pediatric liquid medications. Little is known about parent preferences regarding units, perceptions about moving to milliliters only, and the role of health literacy and prior milliliter-dosing experience. METHODS Cross-sectional analysis of data collected as part of a randomized controlled study in 3 urban pediatric clinics (SAFE Rx for Kids study). English- and Spanish-speaking parents (n = 493) of children aged ≤8 years were randomized to 1 of 4 study arms and given labels and dosing tools which varied in label instruction format (text plus pictogram, text only) and units (milliliter only ["mL"], milliliter/teaspoon ["mL"/"tsp"]). Outcomes included teaspoon preference in dosing instructions and perceived difficulty with milliliter-only dosing. The predictor variable was health literacy (Newest Vital Sign; low [0-1], marginal [2-3], adequate [4-6]). The mediating variable was prior milliliter-dosing experience. RESULTS Over two-thirds of parents had low or marginal health literacy. The majority (>70%) preferred to use milliliters, perceived milliliter-only dosing to be easy, and had prior milliliter-dosing experience; 11.5% had a teaspoon preference, 18.1% perceived milliliter-only dosing will be difficult, and 17.7% had no prior milliliter-dosing experience. Parents with lower health literacy had a higher odds of having a teaspoon preference (low vs adequate: adjusted odds ratio [AOR] = 2.9 [95% confidence interval [CI] 1.3-6.2]), and greater odds of perceiving difficulty with milliliter-only dosing (low vs adequate: AOR = 13.9 [95% CI 4.8-40.6], marginal vs adequate: AOR = 7.1 [95% CI 2.5-20.4]). Lack of experience with milliliter dosing partially mediated the impact of health literacy. CONCLUSIONS Most parents were comfortable with milliliter-only dosing. Parents with low health literacy were more likely to perceive milliliter-only dosing to be difficult; educational efforts will need to target this group to ensure safe medication use.
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Affiliation(s)
- Alejandro Torres
- Department of Pediatrics, NYU School of Medicine, Bellevue Hospital, New York, NY
| | - Ruth M Parker
- Department of Medicine, Emory University School of Medicine, Atlanta, Ga
| | - Lee M Sanders
- Department of Pediatrics, Stanford University School of Medicine, Stanford, Calif
| | - Michael S Wolf
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Stacy Cooper Bailey
- Department of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, Chapel Hill, NC
| | - Deesha A Patel
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Jessica J Jimenez
- Department of Pediatrics, NYU School of Medicine, Bellevue Hospital, New York, NY
| | - Kwang-Youn A Kim
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Benard P Dreyer
- Department of Pediatrics, NYU School of Medicine, Bellevue Hospital, New York, NY
| | - Alan L Mendelsohn
- Department of Pediatrics, NYU School of Medicine, Bellevue Hospital, New York, NY
| | - H Shonna Yin
- Department of Pediatrics, NYU School of Medicine, Bellevue Hospital, New York, NY; Department of Population Health, NYU School of Medicine, New York, NY.
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Ancker JS, Send A, Hafeez B, Osorio SN, Abramson E. Health IT Usability Focus Section: Adapting EHR-Based Medication Instructions to Comply with Plain Language Guidance-A Randomized Experiment. Appl Clin Inform 2017; 8:1127-1143. [PMID: 29241250 DOI: 10.4338/aci-2017-06-ra-0111] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective Patient instructions are generally written by clinicians. However, clinician-centered language is challenging for patients to understand; in the case of pediatric medication instructions, consequences can be serious. Using examples of clinician-written medication instructions from an electronic health record, we conducted an experiment to determine whether parental misinterpretations would be reduced by instructions that followed best practices for plain language.
Methods We selected examples of dosing instructions from after-visit summaries in a commercial electronic health record. A demographically diverse sample of parents and adult caregivers was recruited from an online panel to participate in an English-language experiment, in which they received a comprehension questionnaire with either original after-visit summary instructions or instructions revised to comply with federal and other sources of plain-language guidance.
Results Nine-hundred and fifty-one respondents completed the experiment; 50% were women, the mean age was 36 years, and 38% had less than a 4-year college education. The revisions were associated with an 8 percentage point increase in correct answers overall (from 55% to 63%, p < 0.001), although revisions were not equally effective for all instructions. Health literacy and health numeracy were strong and independent predictors of comprehension. Overall, mistakes on comprehension questions were common, with respondents missing an average of 41% (6.1 of 15) of questions.
Conclusion In this experimental study, a relatively simple intervention of revising text was associated with a modest reduction in frequency of misinterpretations of medication instructions. As a supplement to more intensive high-touch interventions, revising electronic health record output to replace complex language with patient-centered language in an automated fashion is a potentially scalable solution that could reduce medication administration errors by parents.
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Affiliation(s)
- Jessica S Ancker
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York, United States
| | - Alexander Send
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York, United States
| | - Baria Hafeez
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York, United States
| | - Snezana N Osorio
- Department of Pediatrics, Weill Cornell Medicine, New York, New York, United States
| | - Erika Abramson
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York, United States.,Department of Pediatrics, Weill Cornell Medicine, New York, New York, United States
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Abstract
OBJECTIVES A potential cause of medication errors in children is imprecise measurements, particularly using household spoons. There are no regulations requiring dispensing dose delivery devices (DDDs) with liquid prescription medications. Local, regional, and national pharmacy practice patterns are largely unknown. This study sought to determine how frequently devices are provided with prescription pediatric liquid medications with instructions for their use at pharmacies in Bronx, New York, and to examine which pharmacy and pharmacist characteristics are associated with reported practices. METHODS All pharmacies in Bronx, New York, were identified using an online telephone directory. A telephone survey was administered to the senior-level pharmacist that elicited availability of DDDs, whether pharmacy policy regarding dispensing devices existed, the pharmacist's personal practice of dispensing devices, and years in practice. RESULTS In total, 268 pharmacies were contacted; 214 had free DDDs (79.9%) most of the time, 97.8% had them available to buy, and 160 (59.7%) had no policy regarding dispensing devices. Overall, 199 pharmacists (74.3%) routinely dispensed devices, and 195 (73.3%) demonstrated the use of devices. However, 94 pharmacists (35.3%) recommended using a household spoon to measure correct doses at least some of the time. Pharmacists were less likely to give devices as their years in practice increased. CONCLUSIONS In our study, many Bronx pharmacies had no policy regarding dispensing DDDs for prescription liquid medications, and dispensing practices varied among pharmacists based on years in practice. If similar trends are found in other areas, standardizing pharmacy policy and pharmacists' practices may decrease morbidity in children due to medication measurement errors.
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Pediatric Nurses' Perspectives on Medication Teaching in a Children's Hospital. J Pediatr Nurs 2017; 36:225-231. [PMID: 28888507 DOI: 10.1016/j.pedn.2017.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 06/02/2017] [Accepted: 07/06/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE To explore inpatient pediatric nurses' current experiences and perspectives on medication teaching. DESIGN AND METHODS A descriptive qualitative study was conducted at a Midwest pediatric hospital. Using convenience sampling, 26 nurses participated in six focus groups. Data were analyzed in an iterative group coding process. RESULTS Three themes emerged. 1) Medication teaching is an opportunity. 2) Medication teaching is challenging. Nurses experienced structural and process challenges to deliver medication teaching. Structural challenges included the physical hospital environment, electronic health record, and institutional discharge workflow while process challenges included knowledge, relationships and interactions with caregivers, and available resources. 3) Medication teaching is amenable to improvement. CONCLUSION Effective medication teaching with caregivers is critical to ensure safe, quality care for children after discharge. Nursing teaching practices have not changed, despite advances in technology and major changes in hospital care. Nurses face many challenges to conduct effective medication teaching. Improving current teaching practices is imperative in order to provide the best and safest care. PRACTICE IMPLICATIONS This study generated knowledge regarding pediatric nurses' teaching practices, values and beliefs that influence teaching, barriers, and ideas for how to improve medication teaching. Results will guide the development of targeted interventions to promote successful medication teaching practices.
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Glick AF, Farkas JS, Nicholson J, Dreyer BP, Fears M, Bandera C, Stolper T, Gerber N, Yin HS. Parental Management of Discharge Instructions: A Systematic Review. Pediatrics 2017; 140:e20164165. [PMID: 28739657 PMCID: PMC5527669 DOI: 10.1542/peds.2016-4165] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/17/2017] [Indexed: 12/24/2022] Open
Abstract
CONTEXT Parents often manage complex instructions when their children are discharged from the inpatient setting or emergency department (ED); misunderstanding instructions can put children at risk for adverse outcomes. Parents' ability to manage discharge instructions has not been examined before in a systematic review. OBJECTIVE To perform a systematic review of the literature related to parental management (knowledge and execution) of inpatient and ED discharge instructions. DATA SOURCES We consulted PubMed/Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, and Cochrane CENTRAL (from database inception to January 1, 2017). STUDY SELECTION We selected experimental or observational studies in the inpatient or ED settings in which parental knowledge or execution of discharge instructions were evaluated. DATA EXTRACTION Two authors independently screened potential studies for inclusion and extracted data from eligible articles by using a structured form. RESULTS Sixty-four studies met inclusion criteria; most (n = 48) were ED studies. Medication dosing and adherence errors were common; knowledge of medication side effects was understudied (n = 1). Parents frequently missed follow-up appointments and misunderstood return precaution instructions. Few researchers conducted studies that assessed management of instructions related to diagnosis (n = 3), restrictions (n = 2), or equipment (n = 1). Complex discharge plans (eg, multiple medicines or appointments), limited English proficiency, and public or no insurance were associated with errors. Few researchers conducted studies that evaluated the role of parent health literacy (ED, n = 5; inpatient, n = 0). LIMITATIONS The studies were primarily observational in nature. CONCLUSIONS Parents frequently make errors related to knowledge and execution of inpatient and ED discharge instructions. Researchers in the future should assess parental management of instructions for domains that are less well studied and focus on the design of interventions to improve discharge plan management.
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Affiliation(s)
- Alexander F Glick
- New York University School of Medicine, New York, New York; and
- Bellevue Hospital Center, New York, New York
| | - Jonathan S Farkas
- New York University School of Medicine, New York, New York; and
- Bellevue Hospital Center, New York, New York
| | | | - Benard P Dreyer
- New York University School of Medicine, New York, New York; and
- Bellevue Hospital Center, New York, New York
| | - Melissa Fears
- New York University School of Medicine, New York, New York; and
- Bellevue Hospital Center, New York, New York
| | - Christopher Bandera
- New York University School of Medicine, New York, New York; and
- Bellevue Hospital Center, New York, New York
| | - Tanya Stolper
- New York University School of Medicine, New York, New York; and
- Bellevue Hospital Center, New York, New York
| | - Nicole Gerber
- New York University School of Medicine, New York, New York; and
- Bellevue Hospital Center, New York, New York
| | - H Shonna Yin
- New York University School of Medicine, New York, New York; and
- Bellevue Hospital Center, New York, New York
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Jones AN, Miller JL, Neely S, Ibach BW, Hagemann TM, Golding CL, Lewis TV, Peek LA, Johnson PN. Prevalence of Unrounded Medication Doses and Associated Factors Among Hospitalized Pediatric Patients. J Pediatr Pharmacol Ther 2017; 22:286-292. [PMID: 28943824 DOI: 10.5863/1551-6776-22.4.286] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES This study aims to determine the prevalence and factors associated with unrounded doses ordered via a computerized prescriber order entry (CPOE) system among children during a 1-week reference period. METHODS This retrospective, cross-sectional study included children younger than 18 years admitted during a 7-day period. An unrounded dose was defined as an unrounded actual dose (eg, dose calculated to the tenths place for non-neonatal intensive care (non-NICU) patients and dose calculated to the hundredth place for NICU patients) or unrounded volume per dose [eg, <0.1 mL for non-NICU patients and <0.01 mL for NICU patients]. A multilevel logistic regression model was used to determine the prevalence and factors associated with unrounded doses via a CPOE system with adjustment for clustering effects. RESULTS A total of 395 patients were admitted with 391 receiving medications. The overall prevalence of unrounded doses was 30% among the 2426 doses administered. Patients on the NICU team had the highest prevalence of unrounded doses. The odds of an unrounded dose were 4% (adjusted odds ratio, 0.96; 95% confidence interval, 0.94-0.98) lower with each additional kilogram increase in weight after controlling for age, route, scheduled versus as-needed administration, and cluster effects. CONCLUSIONS The prevalence of unrounded doses was higher than in previous studies. It was higher in smaller children after controlling for age, medication-related variables, and clustering. Future studies should focus on the role of CPOE in preventing unrounded and unmeasurable doses and if these strategies affect clinical outcomes (eg, adverse drug events).
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Solanki R, Mondal N, Mahalakshmy T, Bhat V. Medication errors by caregivers at home in neonates discharged from the neonatal intensive care unit. Arch Dis Child 2017; 102:651-654. [PMID: 28468867 DOI: 10.1136/archdischild-2016-311877] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 01/26/2017] [Accepted: 03/18/2017] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To determine the frequency of medication errors by caregivers at home in neonates discharged from the neonatal intensive care unit and to identify the associated risk factors. METHODS A descriptive, cross-sectional study was conducted in the High Risk Newborn Follow-up Clinic of our institute, on a sample of 166 children, <3 months old. The medications prescribed (syrup preparations of vitamin D, multivitamins, calcium, iron and levetiracetam, tablet L-thyroxine and ursodeoxycholic acid and human milk fortifier powder) were noted from the discharge summary. The caregiver who usually administered the medicines to the child at home was asked the names of the medications, frequency of their administration and to show in a measuring cup/syringe/dropper the dose of the medication. The names, doses and frequency of the drugs as reported were matched against those actually prescribed in the discharge summary. Various risk factors probably associated with medication errors, were noted. RESULTS The frequency of medication errors by caregivers in infants discharged from the neonatal intensive care unit was 66.3%. Dose administration error, that is, measurement of a dose different from what was prescribed was the most common error (54%). A prescription containing more than three drugs was found to have statistically significant association (OR 4.19, CI 1.59 to 11.07, p=0.00). CONCLUSION Medication errors by caregivers in infants less than 3 months of age are very common, dose administration error being the most common type. A prescription of more than three drugs increases the odds of an error.
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Affiliation(s)
- Ritanshu Solanki
- Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Nivedita Mondal
- Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Thulasingam Mahalakshmy
- Department of P&SM, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Vishnu Bhat
- Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
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Yin HS, Parker RM, Sanders LM, Mendelsohn A, Dreyer BP, Bailey SC, Patel DA, Jimenez JJ, Kim KYA, Jacobson K, Smith MC, Hedlund L, Meyers N, McFadden T, Wolf MS. Pictograms, Units and Dosing Tools, and Parent Medication Errors: A Randomized Study. Pediatrics 2017; 140:peds.2016-3237. [PMID: 28759396 PMCID: PMC5495522 DOI: 10.1542/peds.2016-3237] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Poorly designed labels and dosing tools contribute to dosing errors. We examined the degree to which errors could be reduced with pictographic diagrams, milliliter-only units, and provision of tools more closely matched to prescribed volumes. METHODS This study involved a randomized controlled experiment in 3 pediatric clinics. English- and Spanish-speaking parents (n = 491) of children ≤8 years old were randomly assigned to 1 of 4 groups and given labels and dosing tools that varied in label instruction format (text and pictogram, or text only) and units (milliliter-only ["mL"] or milliliter/teaspoon ["mL/tsp"]). Each parent measured 9 doses of liquid medication (3 amounts [2, 7.5, and 10 mL] and 3 tools [1 cup, 2 syringes (5- and 10-mL capacities)]) in random order. The primary outcome was dosing error (>20% deviation), and large error (>2× dose). RESULTS We found that 83.5% of parents made ≥1 dosing error (overdosing was present in 12.1% of errors) and 29.3% of parents made ≥1 large error (>2× dose). The greatest impact on errors resulted from the provision of tools more closely matched to prescribed dose volumes. For the 2-mL dose, the fewest errors were seen with the 5-mL syringe (5- vs 10-mL syringe: adjusted odds ratio [aOR] = 0.3 [95% confidence interval: 0.2-0.4]; cup versus 10-mL syringe: aOR = 7.5 [5.7-10.0]). For the 7.5-mL dose, the fewest errors were with the 10-mL syringe, which did not necessitate measurement of multiple instrument-fulls (5- vs 10-mL syringe: aOR = 4.0 [3.0-5.4]; cup versus 10-mL syringe: aOR = 2.1 [1.5-2.9]). Milliliter/teaspoon was associated with more errors than milliliter-only (aOR = 1.3 [1.05-1.6]). Parents who received text only (versus text and pictogram) instructions or milliliter/teaspoon (versus milliliter-only) labels and tools made more large errors (aOR = 1.9 [1.1-3.3], aOR = 2.5 [1.4-4.6], respectively). CONCLUSIONS Provision of dosing tools more closely matched to prescribed dose volumes is an especially promising strategy for reducing pediatric dosing errors.
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Affiliation(s)
- H. Shonna Yin
- Department of Pediatrics, New York University School of Medicine, NYC Health + Hospitals/Bellevue, New York, New York;,Department of Population Health, New York University School of Medicine, New York, New York
| | | | - Lee M. Sanders
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Alan Mendelsohn
- Department of Pediatrics, New York University School of Medicine, NYC Health + Hospitals/Bellevue, New York, New York;,Department of Population Health, New York University School of Medicine, New York, New York
| | - Benard P. Dreyer
- Department of Pediatrics, New York University School of Medicine, NYC Health + Hospitals/Bellevue, New York, New York
| | - Stacy Cooper Bailey
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Chapel Hill, North Carolina
| | | | - Jessica J. Jimenez
- Department of Pediatrics, New York University School of Medicine, NYC Health + Hospitals/Bellevue, New York, New York
| | - Kwang-Youn A. Kim
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kara Jacobson
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Michelle C.J. Smith
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Laurie Hedlund
- Division of General Internal Medicine and Geriatrics and
| | - Nicole Meyers
- Department of Pediatrics, New York University School of Medicine, NYC Health + Hospitals/Bellevue, New York, New York
| | - Terri McFadden
- Pediatrics, Emory University School of Medicine, Atlanta, Georgia; and
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Green JL, Wang GS, Reynolds KM, Banner W, Bond GR, Kauffman RE, Palmer RB, Paul IM, Dart RC. Safety Profile of Cough and Cold Medication Use in Pediatrics. Pediatrics 2017; 139:peds.2016-3070. [PMID: 28562262 DOI: 10.1542/peds.2016-3070] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/28/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The safety of cough and cold medication (CCM) use in children has been questioned. We describe the safety profile of CCMs in children <12 years of age from a multisystem surveillance program. METHODS Cases with adverse events (AEs) after ingestion of at least 1 index CCM ingredient (brompheniramine, chlorpheniramine, dextromethorphan, diphenhydramine, doxylamine, guaifenesin, phenylephrine, and pseudoephedrine) in children <12 years of age were collected from 5 data sources. An expert panel determined relatedness, dose, intent, and risk factors. Case characteristics and AEs are described. RESULTS Of the 4202 cases reviewed, 3251 (77.4%) were determined to be at least potentially related to a CCM, with accidental unsupervised ingestions (67.1%) and medication errors (13.0%) the most common exposure types. Liquid (67.3%), pediatric (75.5%), and single-ingredient (77.5%) formulations were most commonly involved. AEs occurring in >20% of all cases included tachycardia, somnolence, hallucinations, ataxia, mydriasis, and agitation. Twenty cases (0.6%) resulted in death; most were in children <2 years of age (70.0%) and none involved a therapeutic dose. The overall reported AE rate was 0.573 cases per 1 million units (ie, tablets, gelatin capsules, or liquid equivalent) sold (95% confidence interval, 0.553-0.593) or 1 case per 1.75 million units. CONCLUSIONS The rate of AEs associated with CCMs in children was low. Fatalities occurred even less frequently. No fatality involved a therapeutic dose. Accidental unsupervised ingestions were the most common exposure types and single-ingredient, pediatric liquid formulations were the most commonly reported products. These characteristics present an opportunity for targeted prevention efforts.
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Affiliation(s)
- Jody L Green
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, Colorado;
| | - George Sam Wang
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kate M Reynolds
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, Colorado
| | - William Banner
- Oklahoma Center for Poison and Drug Information, Oklahoma University College of Pharmacy, Oklahoma City, Oklahoma
| | - G Randall Bond
- Faculty of Medicine, Hope Africa University, Bujumbura, Burundi
| | - Ralph E Kauffman
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri; and
| | - Robert B Palmer
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, Colorado
| | - Ian M Paul
- Departments of Pediatrics and.,Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Richard C Dart
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, Colorado
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Liquid Medication Dosing Errors by Hispanic Parents: Role of Health Literacy and English Proficiency. Acad Pediatr 2017; 17:403-410. [PMID: 28477800 PMCID: PMC5424611 DOI: 10.1016/j.acap.2016.10.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 09/26/2016] [Accepted: 10/03/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Hispanic parents in the United States are disproportionately affected by low health literacy and limited English proficiency (LEP). We examined associations between health literacy, LEP, and liquid medication dosing errors in Hispanic parents. METHODS Cross-sectional analysis of data from a multisite randomized controlled experiment to identify best practices for the labeling/dosing of pediatric liquid medications (SAFE Rx for Kids study); 3 urban pediatric clinics. Analyses were limited to Hispanic parents of children aged ≤8 years with health literacy and LEP data (n = 1126). Parents were randomized to 1 of 5 groups that varied by pairing of units of measurement on the label/dosing tool. Each parent measured 9 doses (3 amounts [2.5, 5, 7.5 mL] using 3 tools [2 syringes in 0.2 or 0.5 mL increments, and 1 cup]) in random order. Dependent variable was a dosing error of >20% dose deviation. Predictor variables included health literacy (Newest Vital Sign) (limited = 0-3; adequate = 4-6) and LEP (speaks English less than "very well"). RESULTS A total of 83.1% made dosing errors (mean [SD] errors per parent = 2.2 [1.9]). Parents with limited health literacy and LEP had the greatest odds of making a dosing error compared to parents with adequate health literacy who were English proficient (trials with errors per parent = 28.8 vs 12.9%; adjusted odds ratio = 2.2 [95% confidence interval 1.7-2.8]). Parents with limited health literacy who were English proficient were also more likely to make errors (trials with errors per parent = 18.8%; adjusted odds ratio = 1.4 [95% confidence interval 1.1-1.9]). CONCLUSIONS Dosing errors are common among Hispanic parents; those with both LEP and limited health literacy are at particular risk. Further study is needed to examine how the redesign of medication labels and dosing tools could reduce literacy- and language-associated disparities in dosing errors.
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Shonna Yin H. Health Literacy and Child Health Outcomes: Parental Health Literacy and Medication Errors. SPRINGERBRIEFS IN PUBLIC HEALTH 2017. [DOI: 10.1007/978-3-319-50799-6_3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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50
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Parand A, Garfield S, Vincent C, Franklin BD. Carers' Medication Administration Errors in the Domiciliary Setting: A Systematic Review. PLoS One 2016; 11:e0167204. [PMID: 27907072 PMCID: PMC5132322 DOI: 10.1371/journal.pone.0167204] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 11/10/2016] [Indexed: 11/18/2022] Open
Abstract
Purpose Medications are mostly taken in patients’ own homes, increasingly administered by carers, yet studies of medication safety have been largely conducted in the hospital setting. We aimed to review studies of how carers cause and/or prevent medication administration errors (MAEs) within the patient’s home; to identify types, prevalence and causes of these MAEs and any interventions to prevent them. Methods A narrative systematic review of literature published between 1 Jan 1946 and 23 Sep 2013 was carried out across the databases EMBASE, MEDLINE, PSYCHINFO, COCHRANE and CINAHL. Empirical studies were included where carers were responsible for preventing/causing MAEs in the home and standardised tools used for data extraction and quality assessment. Results Thirty-six papers met the criteria for narrative review, 33 of which included parents caring for children, two predominantly comprised adult children and spouses caring for older parents/partners, and one focused on paid carers mostly looking after older adults. The carer administration error rate ranged from 1.9 to 33% of medications administered and from 12 to 92.7% of carers administering medication. These included dosage errors, omitted administration, wrong medication and wrong time or route of administration. Contributory factors included individual carer factors (e.g. carer age), environmental factors (e.g. storage), medication factors (e.g. number of medicines), prescription communication factors (e.g. comprehensibility of instructions), psychosocial factors (e.g. carer-to-carer communication), and care-recipient factors (e.g. recipient age). The few interventions effective in preventing MAEs involved carer training and tailored equipment. Conclusion This review shows that home medication administration errors made by carers are a potentially serious patient safety issue. Carers made similar errors to those made by professionals in other contexts and a wide variety of contributory factors were identified. The home care setting should be a priority for the development of patient safety interventions.
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Affiliation(s)
- Anam Parand
- Department of Social Psychology, The London School of Economics, London, United Kingdom / The National Institute for Health Research (NIHR) Imperial Patient Safety Translational Research Centre, Imperial College London, London, United Kingdom
- * E-mail:
| | - Sara Garfield
- Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust / Research Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom
| | - Charles Vincent
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - Bryony Dean Franklin
- Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust / Research Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom
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