A new study from researchers at Monroe Carell, Jr. Children’s Hospital at Vanderbilt, Vanderbilt University School of Medicine, posited that health literacy–informed communication strategies during medication counseling might be able to reduce dosing errors, but they said that these had not been tested in the pediatric hospital setting.
The study team sought to determine if health literacy–informed communication intervention, compared with standard counseling, reduces discharge medication errors in hospitalized children of English- and Spanish-speaking caregivers. The results were published recently in the Journal of the American Medical Association Network Open.
The randomized clinical trial included 198 caregivers of hospitalized children. It determined that a health literacy–informed communication intervention (written, pictogram-based medication instruction sheet, liquid medication dosing demonstration, and structured teach back and show back) resulted in significantly fewer caregiver medication errors and more accurate caregiver medication knowledge compared with standard counseling.
“Findings of this trial indicate that health literacy–informed communication tools improve the safety of the discharge medication counseling process and should be the standard of care to facilitate safe transitions from hospital discharge to home,” the authors wrote.
A parallel, randomized clinical trial was performed from June 22, 2021, to August 20, 2022, at a tertiary care, U.S. children’s hospital. The analysis included English- and Spanish-speaking caregivers of hospitalized children aged 6 years or younger who were prescribed a new, scheduled liquid medication at discharge. The 198 randomized caregivers had a mean age of 31.4 years, and were 93.9% women. Most (79.8%) were white, and 18.2% were Latino. The primary outcome was available for 151 (76.3%) caregivers.
The intervention was delivered by a study team member. The focus was on 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. The secondary outcome was defined as caregiver-reported medication knowledge.
The results indicated that 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).
The researchers reported that 24 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). In addition, the researchers said that “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).”
No differences were identified in knowledge of medication name, indication, frequency, or storage, however.
“A health literacy–informed discharge medication communication bundle reduced home liquid medication administration errors and enhanced caregiver medication knowledge compared with standard counseling,” the study concluded. “Routine use of these standardized strategies can promote patient safety following hospital discharge.”
Background information in the article noted that errors in pediatric medication dosing are common, with approximately one out-of-hospital medication error occurring every 8 minutes among children aged younger than 6 years.
“Liquid medications account for most pediatric dosing errors, likely due to inherent dosing complexities, including weight-based dosing, varying medication concentrations, and use of nonstandardized dosing instruments,” the researchers wrote. “The posthospitalization period may be an especially vulnerable time for medication errors. To date, however, most work on reducing pediatric out-of-hospital medication errors have focused on clinic or emergency department settings, and no randomized interventions, to our knowledge, have been investigated in the inpatient setting.”
One issue is that only 15% of parents possess proficient levels of health literacy, and limited health literacy has been associated with a 1.5- to 2.5-fold increased odds of liquid medication dosing errors, the study pointed out.
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