Medication management of febrile children: a qualitative study on pharmacy employees’ experiences

Abstract

Background While fever is mostly self-limiting, antibiotic prescription rates for febrile children are high. Although every parent who receives a prescription visits a pharmacy, we have limited insight into pharmacy employees’ experiences with these parents. Pharmacy employees do however exert an important role in ensuring children receive correct dosages and in advising parents on administration of antibiotics. Objective To describe pharmacists’ and pharmacy assistants’ experiences with parents contacting a pharmacy for their febrile child, and to identify ways of improving medication management of these children. Setting Community pharmacies in the Netherlands. Method A qualitative study including 24 Dutch pharmacy employees was conducted, performing four focus group discussions among pharmacy employees. Analysis was based on constant comparative technique using open and axial coding. Main outcome measure Pharmacy employees’ experiences with parents contacting a pharmacy for their febrile child. Results Three categories were identified: (1) workload and general experience, (2) inconsistent information on antibiotic prescriptions, (3) improving communication and collaboration. Pharmacy employees experienced that dosing errors in antibiotic prescriptions occur frequently and doctors provide inconsistent information on prescriptions. Consequently, they have to contact doctors, resulting in a higher workload for both stakeholders. They believe this can be improved by providing the indication for antibiotics on prescriptions, especially when deviating from standard dosages. Conclusion Pharmacy employees experience a high amount of dosing errors in paediatric antibiotic prescriptions. Providing the indication for antibiotics in febrile children on prescriptions, especially when deviating from standard dosages, can potentially reduce dosage errors and miscommunication between doctors and pharmacy employees.

Including the Reason for Use on Prescriptions Sent to Pharmacists: Scoping Review

“…Six studies examined pharmacists and physicians jointly in the studies [ 16 - 18 , 21 - 23 ]. In total, 4 studies were conducted in the United States [ 2 , 18 , 21 , 23 ], 2 in Europe [ 20 , 22 ], 1 in the Middle East [ 16 ], and 2 in Australia [ 17 , 19 ]. Two studies focused on prescribing in hospital [ 16 , 22 ], 6 focused on primary care [ 2 , 17 , 19 - 21 , 23 ], and 1 involved a consultation with experts from different settings [ 18 ].…”

“…According to the inclusion criteria, all studies included pharmacists, with 7 also including physicians [ 16 - 19 , 21 - 23 ], 4 included patients [ 18 , 21 - 23 ], and 1 presented results from a pilot study with various stakeholders [ 18 ]. Five studies used a qualitative approach to capture perspectives on the application of reason for use [ 17 , 18 , 20 , 21 , 23 ] and 4 used a quantitative approach to characterize the impact of reason for use [ 2 , 16 , 19 , 22 ]. Three of the included studies were published in health research journals [ 17 , 19 , 22 ], with the remaining 6 published in pharmacy practice journals [ 2 , 16 , 18 , 20 , 21 , 23 ].…”

Community Pharmacy Use by Children across Europe: A Narrative Literature Review

“…In Greece, parents were hesitant to utilise pharmacists because of the lackadaisical attitude to antibiotic sale without prescription, possibly leading to wide scale resistance and adverse events [ 18 ]. A separate study in Netherlands indicated that parents did not trust explanations of doses and administration of drugs from a pharmacist, instead trusting their own limited knowledge more [ 19 ]. In addition to this, UK parents felt that pharmacists simply ‘lacked adequate knowledge’ specifically for their children [ 12 ].…”

Pharmacists’ perspectives on the value of reason for use information

“…This paper joins the few prior studies that have directly engaged pharmacists in conversation on RFU. 4,7 The pharmacists interviewed for this study commented on the privacy considerations of including a medication's indication on the medication label and underscored the importance of respecting individual patients' choices when deciding to add RFU. Despite the increasing body of literature strongly supporting the addition of RFU on medication labels, equal attention must be paid to when the addition of RFU on medication labels may be harmful to patients.…”

“…5,6 The potential of RFU to improve pharmacist workflow and patient care was identified in multiple studies, and its current absence from prescriptions was noted as a barrier to efficient patient counselling. [7][8][9] Adding RFU to prescriptions and medication labels presents clear benefits to all health care providers and patients but is still not part of routine clinical practice. 10 This paper explores the potential impact that adding RFU to prescriptions could have on pharmacy practice.…”