Medication Safety in Paediatric Inpatients – Part 4

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Nearly ten years ago, I undertook an project for my Pharmacy degree, with the title “Minimising Medication Errors for Paediatric Inpatients”. The TGA’s recent alert about Paracetamol dosing and events in in the national news (link to ABC story)* have made me consider some of the newer literature in and around the of inpatient medication safety in children. This post is the fourth in a series of five brief reviews.

Bottom line:

  • 2/3 of parents identify the need to watch over care to ensure mistakes do not happen.
  • Admission with breathing difficulties and higher level of parental education is associated with an increased need to watch over care.
  • Parents and staff have a comparable awareness of the safety climate.
  • “Parent[s] need to see a commitment to safety that exceeds our drive to get the work done.”

In our previously reviewed articles, we’ve identified that kids are at a higher risk of medication errors and adverse drug events. Do parents known this? An interesting paper around this idea by Cox et Al in Wisconsin, sought to identify Parent Perceptions of Children’s Hospital Safety Climate.

Cox ED, Carayon P, Hansen KW, et al. Parent Perceptions of Children’s Hospital Safety Climate BMJ Qual Saf. 2013 August ; 22(8): 664–671. doi:10.1136/bmjqs-2012-001727.

Although parents and healthcare workers view safety differently, both these groups views are of value. The authors aimed to understand the potential value of parent reports of the safety climate in children’s hospitals. To do this, they undertook a survey focused on the areas of safety that were visible to parents, specifically, handovers & transitions, communication openness and overall perceptions of safety. They specifically examined the need to watch over their child’s care.

Who?

233 parents of eligible admissions were invited to take the survey; of the 194 whom consented, 172 returned the survey (87% success rate). One parent per family was surveyed, and admissions with ‘stigmatizing reasons’ (child neglect, psychiatry concerns) were excluded, as were parents unable to consent (absent or sleeping during recruitment visits).

What was asked?

As above, the four safety domains identified as visible to parents were:

    • Overall climate of safety
    • Handover / transitions
    • Communication openness
    • Parent communication (as a separate section), and
    • “Parental perceptions of the need to watch over care to ensure mistakes do not happen.”

Each with three or four questions scored on a five point Likert scale.

The item “Parental perceptions of the need to watch over care to ensure mistakes do not happen”, was identified as relevant as in a previous study, two-thirds of parents identified this concern.

What did they find?

The demographics of this survey revealed most parents responding to the survey were mothers, aged 35 years old, 83% white, and in “good to excellent health”. The most common reason for their child’s hospitalisation (as reported by parents) were breathing problems – 30%, stomach or intestinal problems – 20%, and fever – 17%. Nearly 60% of patients stayed one day, whilst 12% were inpatients for longer than a week.

Overall, parents found the safety climate of the institution as positive; the most positively viewed domain was parent communication.

With regard to the “need to watch over care to prevent mistakes”, this measure ran inversely proportional to the overall perception of safety, and perception of handover/transitions.

Notably, “[w]hen parents overall perceptions of safety were one point higher, the odds of needing to watch over care decreased 80%.” Likewise, for a 1-point increase in the perception of handovers/transition, the  need to watch over care dropped 75%.

The need to watch over care was significantly associated with:

  • admission for breathing difficulties vs all other reasons for admission.
  • higher level of parental education.

The paper’s discussion raises some important points. They identified that survey data from staff perceptions of safety had a good fit with that obtained from parents, in the areas visible to them.

In plain language, parents and staff have a comparable awareness of the safety climate. My interpretation of this is that in those situations where there’s disagreement between staff or the feeling that ‘something’s a bit dicey’, in a visible area, parents are aware of the tension or concern.

The authors identified that the rationale of parent survey for patient safety appears to focus better on the frontline of care, rather than the occasional ‘high impact medical errors’ that existing systems emphasise. It is further postulated that this method holds merit because of the high rate of uptake of parental survey.

Finally, Cox et al. suggest that the need to watch over care, and safety climate domains, suggest potential targets for improving hospital safety. The parents felt more likely to watch over care when they held less positive views of overall safety climate and handovers & transitions. This makes good sense. Importantly, they state that

“parent[s] need to see a commitment to safety that exceeds our drive to get the work done.”

 

References:

Cox ED, Carayon P, Hansen KW, et al. Parent Perceptions of Children’s Hospital Safety Climate BMJ Qual Saf. 2013 August ; 22(8): 664–671. doi:10.1136/bmjqs-2012-001727.

Tarini BA, Lozano P, Christakis DA. Afraid in the hospital: parental concern for errors during a child’s hospitalization. J Hosp Med. 2009; 4(9):521–7. [PubMed: 19653281]

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About 

A Paediatric Trainee based in Queensland, Australia, Henry is passionate about Adolescent Medicine & General Paediatrics, with a strong interest in Medical Education & Clinical Teaching. An admitted nerd & ironman with a penchant for Rubik’s Cubes & ‘Dad jokes’.

@henrygoldstein | + Henry Goldstein | Henry’s DFTB posts

Author: Henry Goldstein

A Paediatric Trainee based in Queensland, Australia, Henry is passionate about Adolescent Medicine & General Paediatrics, with a strong interest in Medical Education & Clinical Teaching. An admitted nerd & ironman with a penchant for Rubik’s Cubes & ‘Dad jokes’.

@henrygoldstein | + Henry Goldstein | Henry’s DFTB posts