Caregiver Medication Management and Understanding After Pediatric Hospital Discharge

Abstract

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 5 .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.

Parent Perceptions and Experiences Regarding Medication Education at Time of Hospital Discharge for Children With Medical Complexity

“…Knowledge of adverse effects of medications has been shown to be a common gap when parents are queried about their child' s medication after discharge. 4,28,29 Parents we interviewed sought this information, suggesting this gap is an opportunity to tailor discharge medication education content. Regarding the delivery of discharge education, adult studies demonstrate that dedicated discharge providers have been associated with lower readmission rates.…”

“…2,3 Parents have been shown to have variable understanding of discharge medication instructions, including medication names, dosages, and durations. 4 Unsurprisingly, outpatient adverse drug events are common, 5 and many families experience at least 1 medication error after hospital discharge. 4,6 Children with medical complexity (CMC), those with long-term medical problems requiring multiple specialists and/or technology dependence for survival, 7 are particularly vulnerable to medication errors after hospital discharge compared with children without complex, chronic disease.…”

“…4 Unsurprisingly, outpatient adverse drug events are common, 5 and many families experience at least 1 medication error after hospital discharge. 4,6 Children with medical complexity (CMC), those with long-term medical problems requiring multiple specialists and/or technology dependence for survival, 7 are particularly vulnerable to medication errors after hospital discharge compared with children without complex, chronic disease. 2,8 To minimize these errors, discharge medication education should provide a critical safety checkpoint before medication management is transitioned back to the family.…”

Implementation of a Standardized Approach to Improve the Pediatric Discharge Medication Process

“…4 Previous research by this group suggests that more than twothirds of caregivers have a discharge medication-related failure, and most instructions lack key medication information after inpatient discharge. 6 The pediatric discharge medication process is complicated, and caregivers have difficulty managing medication instructions, increasing the risk for errors. 7 Recent literature is focused on ED discharges, [8][9][10][11][12][13] with less focus on inpatient discharges.…”

“…19 Our group found that 70% of caregivers mismanage or misunderstand inpatient discharge medications (measured as discharge medication-related failures), particularly related to side effects, duration, and start time after discharge. 6 Thus, systematic processes for ensuring accurate medication management and understanding by caregivers and consistent medication documentation are paramount to promoting safe inpatient discharges. 20 This project's purpose was to improve caregiver medication management and understanding of medications by standardizing the discharge medication process as measured by responses on a telephone questionnaire.…”