Publication History
Submitted: December 05, 2022
Accepted: December 20, 2022
Published: January 01, 2023
Identification
D-0097
Citation
Marie Diack, Derak Stewart, Parshu Kirby & David Moris (2023). Challenges with Parent/Caregiver Medication Administration in Peadiatrics and the Importance of Patient Education: A Systematic Review. Dinkum Journal of Medical Innovations, 2(01):22-28.
Copyright
© 2023 DJMI. All rights reserved
22-28
Challenges with Parent/Caregiver Medication Administration in Peadiatrics and the Importance of Patient Education: A Systematic ReviewReview Article
Marie Diack 1*, Derak Stewart 2, Parshu Kirby 3, David Moris 4
- Nepal Medical College and Teaching Hospital (NMC), Nepal: diackmarie3@gmail.com
- Nepal Medical College and Teaching Hospital (NMC), Nepal: steward001@gmail.com
- Nepal Medical College and Teaching Hospital (NMC), Nepal: parshukirby88@outlook.com
- Nepal Medical College and Teaching Hospital (NMC), Nepal: mariedav09@gmail.com
* Correspondence: diackmarie3@gmail.com
Abstract: The project looks for research that look at drug administration problems that parents and children confront as well as studies that look at health literacy using a validated literacy test. The subsequent search phrases were employed: The first three categories are pediatric, pharmaceutical error, which includes dose, administration, safety, and drug optimization errors, and health literacy. Reference lists were used to manually and methodically search ten electronic databases. Of the 1230 records evaluated, 14 studies met the criteria for inclusion. Three analytical topics emerged from the synthesis. The review emphasized how the frequency and magnitude of dosage errors are influenced by various measurement tools, recommended dosages, and administration guidelines. The sociodemographic traits of the parent, especially their health literacy and language, are crucial factors to consider when creating an intervention to reduce medication administration errors at home. A few potential strategies to reduce medicine administration errors committed by children at home were covered in the review. One of these ideas is to give parents or kids the suggested dosage in addition to spoken instructions. Other recommendations are to provide precise dose intervals, match the suggested dose with the provided measuring tool, and provide visual dosing instructions. The findings suggest that in order to optimize the use of medication by parents, further research is necessary to comprehend the nature of these issues at home. When developing any potential future intervention to reduce medication errors among children and young people at home, it is important to take into account a number of factors, including the sociodemographic characteristics of parents and young people, counseling, medication administration instructions, and measurement tools.
Keywords: medication, administration, peadiatrics, patient education, caregiver, SLR
- INTRODUCTION
It has been reported that youngsters frequently make mistakes when administering medications [1]. More than 40% of parents and caregivers in an outpatient setting make dosing mistakes, according to earlier research [2-4]. Poor patient clinical outcomes and hazardous pharmacological events might arise from incorrect pharmaceutical administration [5]. Drug administration issues at home can have a variety of multifaceted causes, some of which may depend on other circumstances [2]. Therefore, an initial evaluation of the current issues and potential contributing factors must be recognized in order to enhance medicine administration by parents and patients. While previous research has identified potential risk factors for clinician-led medication administration errors in children, no studies have documented the types and risk factors associated with medication administration errors in young people as well as caregivers [6, 7]. The European Health Literacy Survey, which was carried out in eight different nations, indicates that between 29% and 62% of people have low health literacy [8, 9]. Because of this, there is a significant frequency of low health literacy and a possible link between it and problems with children’s medicine administration. Using a validated measure to assess literacy, the review sought to uncover research that examined health literacy issues related to drug administration faced by parents and children. The prevalent issues with medication administration that arise at home, as well as potential causes and risk factors besides health literacy that may exacerbate medication administration errors, have all been emphasized in this systematic study.
- MATERIALS AND METHODS
The Cochrane Handbook for Systematic Reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting criteria were followed in the conduct of this review [10–11]. No patients or members of the public were involved in the planning, execution, reporting, or distribution of this review. A study might be included if it addressed pharmaceutical administration errors in children and adolescents in the WHO population age range, which is defined as 0–18 years old. This contains research detailing pharmaceutical-related issues that arise when a parent or child is in charge of giving or taking the medication outside of a therapeutic setting. Research must have used a validated health literacy assessment tool to determine participants’ levels of health literacy. First created by the study team, the search method was validated using the Population, Intervention, Comparison, and Outcomes model by an information specialist. The reviewer (DTD) conducted a thorough search for studies from the database’s launch until September 2020 using PubMed, Scopus, Web of Science, Cochrane Library, OpenGrey, NHS Digital Department of Health Office for National Statistics, BBC News, Bielefeld Academic Search Engine, E-thesis Online Service, and Conference proceedings via Web of Science. To find any more papers that might be included in the review, DTD tracked out references for every study that was included. In order to minimize bias, each study was independently assessed by two reviewers based on the aforementioned inclusion criteria. Every recognized study’s title and/or abstract, as well as any complete papers that seemed possibly pertinent, were independently reviewed. A prepared, standardized spreadsheet was used by two reviewers to independently extract data. If required, a third reviewer (CH) conducted a consensus discussion to address discrepancies in the extracted data. Analytical themes were used to combine and condense the results. The research team used thematic analysis because of its adaptability and capacity to spot patterns of important information within the data [12–14].
- RESULTS
1230 documents in all were found using database searches and other methods. Following the screening of abstracts and titles, 38 publications were collected in full text and their eligibility evaluated. 14 of them fulfilled the requirements for inclusion and were examined in the study [15–28]. Most of the featured studies were released during the previous 12 months. Every study (n = 14) was conducted anywhere in the world. In total, 11 studies enrolled parents or other caregivers of children between the ages of 30 days and less than 9 years; two studies enrolled parents without regard to the child’s age restrictions; and one study exclusively enrolled women who were capable of bearing children. The ethnic makeup of the recruited sample was disclosed by the bulk of the studies (n = 13), and it was primarily made up of Black or Hispanic parents or caregivers. Only women with a white ethnic origin were recruited for one research [22]. The final synthesis comprised all recognized studies, with a focus on the higher quality studies. Among the most frequent drug mistakes made by parents, according to eight of the included studies, are pediatric dosage errors [15, 18–21, 23, 24, 26]. Parents who made underdosing errors were shown to make more dosage and frequency errors than those who made overdosing errors, according to a study by Morrison et al20. Based on the included research, it was observed that the measurement method parents employed and the dose volume (amount) had an impact on the amount and frequency of dosing errors by parents. Parents reported in one study that their main dosage tool was an unstandardized kitchen spoon [17]. According to two studies, measuring cups are more likely than syringes to contain errors, especially when dealing with small dose volumes (amounts) [21, 24]. The majority of parents in a cross-sectional study done in the USA (66% of them) thought that oral syringes were the best tool for accurate dosing, followed by cups (23.5%) and dosing spoons, measuring spoons, kitchen teaspoons, and droppers (10.1%) [27]. According to a different study, parents using cups with printed and etched markings made larger dosing errors (>40% deviation of the recommended dose). This was assumed to be caused by misunderstandings regarding teaspoon versus tablespoon instructions and the belief that the entire cup represents the dose [16]. When the units on the pharmaceutical bottle label differed from the units on the dosing instrument, parents made serious dosage mistakes [24]. When measuring the recommended and intended amount, parents who used teaspoon/tablespoon units were more likely to use a non-standardized dosing tool and make mistakes [19]. The kind of instructions given was the last possible consideration. When it came to liquid medication, parents who received text-plus-pictogram instructions made fewer mistakes (43.9%) than those who received text-only instructions (59.0%). Additionally, this group was less likely to overdose [26]. Compared to parents who received pictogram teaching (5.4%), parents who received normal pharmaceutical counseling were 47.8% more likely to make dosage errors [25]. The studies’ caregivers’ health literacy was evaluated, and six of them went on to analyze the impact of this literacy on medication errors by looking at other cofactors and dose accuracy. When compared to caregivers with appropriate health literacy, Yin et al. [17] found that caregivers with inadequate or marginal health literacy were more likely to utilize a non-standardized dosing instrument and were also less knowledgeable about weight-based dosing for over-the-counter medication. A substantial correlation was discovered in another study by Yin et al. [16] between health literacy and dosage errors made using cups and dosing spoons. Parents with poor literacy reported that dosing cups were their preferred tool most of the time. Williams et al.’s adjusted analysis [27] revealed a high correlation between health literacy levels and measurement instrument preference in specific cups. The parents who made the greatest dosage mistakes were those with inadequate health literacy and limited English proficiency (LEP), according to Harris et al. [21]. Similar findings were made by Samuels-Kalow et al. (18), but their sample size was less than that of the group with adequate health literacy. Parents with inadequate and marginal health literacy were also shown to have made dosage errors. Compared to 54.1% of carers with adequate health literacy, 88.6% of caregivers with poor or marginal health literacy were not aware of weight-based dosage for English-speaking caregivers [17]. In contrast to the control group, which received standard medication counseling, parents from low sociodemographic status who were prescribed a daily dose and who received simple language, pictogram instruction sheets, were less likely to make mistakes in their knowledge of dose frequency and dose accuracy (0% vs. 15.1%), according to Yin et al. [25]. Incorrect medication preparation, defined as shaking the medicine before administration for both daily doses (10.9% vs. 28.3%, p=0.04) and as-needed medication (21.5% vs. 43.0%), was less common among participants in the interventional group. [25]. Compared to the parents in the standard group, the interventional group’s participants were less likely to utilize a non-standardized measurement method (daily dose: 93.5% vs 71.7%; as needed: 93.7% vs 74.7%) [25]. In a cross-sectional study, Torres et al. [28] examined parents’ preferences and perceptions of measurement units by analyzing data from a randomized control study. When creating an intervention to prevent drug delivery errors, four studies recommended taking parental sociodemographic risk variables into account [16–17, 21–26]. Parents’ language and health literacy were two of these characteristics. According to Kalow et al., there has to be a more systematic strategy implemented to determine the patient’s preferred language for communication in addition to continuing efforts to streamline interpretation services [18]. Combining verbal counseling with provisional dose counseling, which involves demonstrating to the patient how to prepare the dose, may reduce the likelihood of dosing errors, according to three studies [15–23]. A promising approach that may help to lower pediatric dosing errors was proposed by Yin et al. It involved matching the dosing tool to the recommended dose volume, switching to milliliter-only units, and simplifying the numerical markings on the measurement tools [24, 26, 28]. According to a research by Wallace et al. [22], some parents would prefer directions that provide clear dosage intervals, with the precise time and dose listed on the label.
- DISCUSSION
The study’s findings imply that parents seem to make a variety of medication mistakes, especially when it comes to liquid drugs, as supported by earlier research from the USA and this review’s studies [23–25]. In line with another analysis on Spanish-speaking Latino parents, the majority of the included studies showed that dosing errors were among the most frequent medication errors made by parents [25–29]. This research found that, according to studies published in the USA, parents continue to utilize non-standard liquid dosage instruments as their primary measuring tool; Yaffe et al. and McMahon et al. have previously connected this practice to medicine administration problems. [31–30] The review discovered that, in the case of milliliter-only labels and tools in particular, matching the medication labels to the closest measurement tool size may be linked to lower rates of parent dosing and administering errors as well as lower chances of parents using nonstandard measurement tools, as suggested by other studies [32–45]. Four research made it clear that any future intervention aiming at lowering parental dose and administration errors needs to take sociodemographic factors like health literacy and language into account. The review’s findings brought to light a number of initiatives that patients and parents may use to help lower drug administration errors that happen at home. This includes using pictographic instructions, which were consistent in four of the included studies [15 23 25 26], together with clear English and instructions on how to use the offered dosage tool. This study highlighted prospective areas that, if implemented into actual practice, could aid in lowering medication administration errors made by patients, parents, and carers. Personalized coaching and training that can adjust to various languages and health literacy levels, as well as matching the dosage tool to the recommended volume and using milliliter units, are examples of potential techniques. We have identified many limitations in our review. Our research was significantly limited by two factors. First, as we only considered English-language studies, there may be publication bias and non-English studies that are pertinent to this subject may have gone unnoticed. Secondly, we restricted our inclusion to research that employed a validated instrument to assess literacy. As a result, only American studies were considered. The issue of literacy affects all nations, but it is particularly critical in low- and middle-income nations. These papers should be included in future evaluations by expanding the search parameters. Additionally, while the study intended to include issues related to drug administration for younger individuals, specifically those between the ages of 16 and 18, none were included since they did not meet the qualifying requirements for this evaluation. Future studies using participants who are younger—between the ages of 16 and 18—are required. Furthermore, because most of the investigations were carried out in the USA and were from the same research group, Yin et al., the generalizability of the study outcomes may be poor. Several drawbacks have been brought to light by this study group’s studies, including the use of hypothetical scenarios that may not accurately reflect how parents measure the dosage at home [16, 23, 24, 26]. The research team found it challenging to preserve blindness in some of the randomized trial studies included in this evaluation because some participants disclosed their assigned group, and no conclusions could be derived about the causes of the cross-sectional investigations [17, 19, 25]. Furthermore, one study’s publication date was 13 years ago [17], meaning that it did not account for changes in treatments that have occurred locally, nationally, and worldwide. Nevertheless, based on new data in 2018 [28], this study emphasizes that non-standard dosing continues to happen today because of parental desire.
- CONCLUSION
The results imply that more effort is required to address the nature of these problems at home in order to maximize medication use by parents. When creating any future potential intervention aimed at reducing medication errors among children and young people at home, sociodemographic characteristics of parents and young people, measurement tools, counseling, and medication administration instructions are some of the areas to be considered.
REFERENCES
- Walsh K, Ryan J, Daraiseh N, et al. Errors and nonadherence in pediatric oral chemotherapy use. Oncology 2016;91:231–6.
- Frush KS, Luo X, Hutchinson P, et al. Evaluation of a method to reduce over-the-counter medication dosing error. Arch Pediatr Adolesc Med 2004;158:620–4.
- Li SF, Lacher B, Crain EF. Acetaminophen and ibuprofen dosing by parents. Pediatr Emerg Care 2000;16:394–7.
- Simon HK, Weinkle DA. Over-The-Counter medications. do parents give what they intend to give? Arch Pediatr Adolesc Med 1997;151:654–6.
- Sil A, Sengupta C, Das AK, et al. A study of knowledge, attitude and practice regarding administration of pediatric dosage forms and allied health literacy of caregivers for children. J Family Med Prim Care 2017;6:636–42.
- Walsh KE, Kaushal R, Chessare JB. How to avoid paediatric medication errors: a user’s guide to the literature. Arch Dis Child 2005;90:698–702.
- McPhillips HA, Stille CJ, Smith D, et al. Potential medication dosing errors in outpatient pediatrics. J Pediatr 2005;147:761–7.
- Rudd RE. Health literacy skills of U.S. adults. Am J Health Behav 2007;31(Suppl 1):8–18.
- Sørensen K, Pelikan JM, Röthlin F, et al. Health literacy in Europe: comparative results of the European health literacy survey (HLS-EU). Eur J Public Health 2015;25:1053–8.
- Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 2010;8:336–41.
- Higgins J, Green S. Cochrane Handbook for systematic reviews of interventions, 2011.
- Clarke V, Braun V, Hayfield N. Thematic analysis. qualitative psychology: a practical guide to research methods, 2015: 222–48.
- Critical Appraisal Skills Programme. CASP (randomised controlled trial) checklist, 2018. Available: https://casp-uk.net/wp-content/ uploads/2018/03/CASP-Randomised-Controlled-Trial-Checklist2018_fillable_form.pdF
- Critical Appraisal Skills Programme. CASP (qualitative) checklist, 2018. Available: https://casp-uk.net/wp-content/uploads/2018/03/ CASP-Qualitative-Checklist-2018_fillable_form.pdf
- Yin HS, Dreyer BP, Moreira HA, et al. Liquid medication dosing errors in children: role of provider counseling strategies. Acad Pediatr 2014;14:262–70.
- Yin HS, Mendelsohn AL, Wolf MS, et al. Parents’ medication administration errors: role of dosing instruments and health literacy. Arch Pediatr Adolesc Med 2010;164:181–6.
- Yin HS, Dreyer BP, Foltin G, et al. Association of low caregiver health literacy with reported use of nonstandardized dosing instruments and lack of knowledge of weight-based dosing. Ambul Pediatr 2007;7:292–8.
- Samuels-Kalow ME, Stack AM, Porter SC. Parental language and dosing errors after discharge from the pediatric emergency department. Pediatr Emerg Care 2013;29:982–7.
- Yin HS, Dreyer BP, Ugboaja DC, et al. Unit of measurement used and parent medication dosing errors. Pediatrics 2014;134:e354–61.
- Morrison AK, Myrvik MP, Brousseau DC, et al. Parents’ pain medication underdosing is associated with more emergency department visits in sickle cell disease. Pediatr Blood Cancer 2018;65:e26906.
- Harris LM, Dreyer BP, Mendelsohn AL, et al. Liquid medication dosing errors by Hispanic parents: role of health literacy and English proficiency. Acad Pediatr 2017;17:403–10.
- Wallace LS, Keenum AJ, DeVoe JE, et al. Women’s understanding of different dosing Instructions for a liquid pediatric medication. J Pediatr Health Care 2012;26:443–50.
- Yin HS, Parker RM, Sanders LM, et al. Pictograms, units and dosing tools, and parent medication errors: a randomized study. Pediatrics 2017;140:e20163237.
- Yin HS, Parker RM, Sanders LM, et al. Liquid medication errors and dosing tools: a randomized controlled experiment. Pediatrics 2016;138. doi:10.1542/peds.2016-0357. [Epub ahead of print: 12 Sep 2016].
- Yin HS, Dreyer BP, van Schaick L, et al. Randomized controlled trial of a pictogram-based intervention to reduce liquid medication dosing errors and improve adherence among caregivers of young children. Arch Pediatr Adolesc Med 2008;162:814–22.
- Yin HS, Mendelsohn AL, Fierman A, et al. Use of a pictographic diagram to decrease parent dosing errors with infant acetaminophen: a health literacy perspective. Acad Pediatr 2011;11:50–7.
- Williams TA, Wolf MS, Parker RM, et al. Parent dosing tool use, beliefs, and access: a health literacy perspective. J Pediatr 2019;215:244–51.
- Torres A, Parker RM, Sanders LM, et al. Parent preferences and perceptions of milliliters and Teaspoons: role of health literacy and experience. Acad Pediatr 2018;18:26–34.
- Leyva M, Sharif I, Ozuah PO. Health literacy among Spanishspeaking Latino parents with limited English proficiency. Ambul Pediatr 2005;5:56–9.
- McMahon SR, Rimsza ME, Bay RC. Parents can dose liquid medication accurately. Pediatrics 1997;100:330–3.
- Yaffe SJ, Bierman CW, Cann HM, et al. Inaccuracies in administering liquid medication. Pediatrics 1975;56:327–8.
- Yin HS, Parker RM, Sanders LM, et al. Liquid medication errors and dosing tools: a randomized controlled experiment. Pediatrics 2016;138:11.
- Dowse R, Ehlers MS. Pictograms in pharmacy. Int J Pharm Pract 1998;6:109–18.
- Dowse R, Ehlers M. Medicine labels incorporating pictograms: do they influence understanding and adherence? Patient Educ Couns 2005;58:63–70.
- Marie Diack & Derak Stewart. Development of Cardiovascular Abnormalities Because of Periodontitis in Nepali Population. Dinkum Journal of Medical Innovations, 1(01):27-30.
- Peter John, Irina Yang & Aparna Goel. A Systematic Literature Review of Importance of Emotional Competence in Healthcare Management. Dinkum Journal of Medical Innovations, 1(01):19-26.
- Nida Ishfaq & Yang Chan. An Analysis of Nutritional Awareness among Diabetic Patients. Dinkum Journal of Medical Innovations, 1(01):13-18.
- Humza Sohail, Markus Peter Chan & Umaima Nagari. Myocarditis after receiving the Covid-19 Vaccine in an Enormous Medical Facility. Dinkum Journal of Medical Innovations, 1(01):07-12.
- Naseem Jamil, Tahir Shamsi & Sara Gill. Literature Review on the Efficiency of Planter Fascia Stretching with Myofascial Release Technique. Dinkum Journal of Medical Innovations, 1(01):01-06.
- Ngoh LN, Shepherd MD. Design, development, and evaluation of visual AIDS for communicating prescription drug Instructions to nonliterate patients in rural Cameroon. Patient Educ Couns 1997;31:245–61.
- Davis TC, Wolf MS, Bass PF, et al. Low literacy impairs comprehension of prescription drug warning labels. J Gen Intern Med 2006;21:847–51.
- Kripalani S, Henderson LE, Chiu EY, et al. Predictors of medication self-management skill in a low-literacy population. J Gen Intern Med 2006;21:852–6.
Publication History
Submitted: December 05, 2022
Accepted: December 20, 2022
Published: January 01, 2023
Identification
D-0097
Citation
Marie Diack, Derak Stewart, Parshu Kirby & David Moris (2023). Challenges with Parent/Caregiver Medication Administration in Peadiatrics and the Importance of Patient Education: A Systematic Review. Dinkum Journal of Medical Innovations, 2(01):22-28.
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© 2023 DJMI. All rights reserved