Parental Management of Discharge Instructions: A Systematic Review

Glick, Alexander F.; Farkas, Jonathan S.; Nicholson, Joey; Dreyer, Benard P.; Fears, Melissa; Bandera, Christopher; Stolper, Tanya; Gerber, Nicole; Yin, H. Shonna

doi:10.1542/peds.2016-4165

Cited by 87 publications

(100 citation statements)

References 96 publications

(191 reference statements)

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“…Although this was not formally tested postdischarge, a more likely possibility is that there may have been greater retention of information in the video group. There is ample evidence that written discharge instructions are often poorly understood or altogether not read . Retention of knowledge has been found to be greater with verbal reinforcement of written discharge instructions, and the video used both verbal and written communication.…”

Section: Discussionmentioning

confidence: 99%

“…Low health literacy and limited English proficiency have been cited as risk factors for errors in management of discharge instructions among parents . Our sampling frame included a relatively large proportion of middle‐income‐class parents with higher education.…”

Section: Limitationsmentioning

confidence: 99%

“…The Seamless Transitions and Re (Admission) Network (STARNet) initiative has focused on improving the transition of care from health care setting to home and adequate discharge instructions are an essential component of optimal transition. Unfortunately, discharge instructions are often complex, and inadequate parental comprehension has been linked to medication errors, suboptimal postdischarge care, and unnecessary return visits .…”

mentioning

confidence: 99%

“…Unfortunately, discharge instructions are often complex, and inadequate parental comprehension has been linked to medication errors, suboptimal postdischarge care, and unnecessary return visits . Among parents who receive discharge instructions in the emergency department (ED), 30% to 50% commit dosing errors and up to 40% fail to administer medications …”

mentioning

confidence: 99%

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Video Discharge Instructions for Acute Otitis Media in Children: A Randomized Controlled Open‐label Trial

Belisle

Dobrin

Elsie

et al. 2019

Academic Emergency Medicine

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Background Thirty percent of children with acute otitis media (AOM) experience symptoms < 7 days after initiating treatment, highlighting the importance of comprehensive discharge instructions. Methods We randomized caregivers of children 6 months to 17 years presenting to the emergency department (ED) with AOM to discharge instructions using a video on management of pain and fever to a paper handout. The primary outcome was the AOM Severity of Symptom (AOM‐SOS) score at 72 hours postdischarge. Secondary outcomes included caregiver knowledge (10‐item survey), absenteeism, recidivism, and satisfaction (5‐item Likert scale). Results A total of 219 caregivers were randomized and 149 completed the 72‐hour follow‐up (72 paper and 77 video). The median (IQR) AOM‐SOS score for the video was significantly lower than paper, even after adjusting for preintervention AOM‐SOS score and medication at home (8 [7–11] vs. 10 [7–13], respectively; p = 0.004). There were no significant differences between video and paper in mean (±SD) knowledge score (9.2 [±1.3] vs. 8.8 [±1.8], respectively; p = 0.07), mean (±SD) number of children that returned to a health care provider (8/77 vs. 10/72, respectively; p = 0.49), mean (±SD) number of daycare/school days missed by child (1.2 [±1.5] vs. 1.1 [±2.1], respectively; p = 0.62), mean (±SD) number of workdays missed by caregiver (0.5 [±1] vs. 0.8 [±2], respectively; p = 0.05), or median (IQR) satisfaction score (5 [4–5] vs. 5 [4–5], respectively; p = 0.3). Conclusions Video discharge instructions in the ED are associated with less perceived AOM symptomatology compared to a paper handout.

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Section: Discussionmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Video Discharge Instructions for Acute Otitis Media in Children: A Randomized Controlled Open‐label Trial

Belisle

Dobrin

Elsie

et al. 2019

Academic Emergency Medicine

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“…Other studies also mention information on drug therapy at home (6,18) and stress that this topic is one of the main concerns of the families. One of the most frequent problems after discharge is errors when following the instructions of medication -which can be minimized when the health worker demonstrates the correct dosage, supervises the dosages, and teaches the parents using standard printed instructions (19) . These strategies can determine the success of treatment since committed adherence to therapy significantly increases the chances of relapse (19) .…”

Section: ] (M8)mentioning

confidence: 99%

Transição de cuidados para o domicílio na perspectiva de pais de filhos com leucemia

Silva-Rodrigues

Bernardo

Alvarenga

et al. 2019

Rev. Gaúcha Enferm.

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Resumo OBJETIVO Descrever as experiências de pais de crianças e adolescentes com leucemia quanto à transição de cuidados do hospital para o domicílio. MÉTODO Estudo qualitativo, descritivo, realizado com nove mães e dois pais, em um hospital público pediátrico de São Paulo-SP. Os dados foram coletados por meio de entrevistas semiestruturadas, de maio de 2016 a janeiro de 2017, organizados no software Atlas.ti 7® e submetidos à análise de conteúdo indutiva. Adotou-se a Teoria das Mudanças como referencial teórico. RESULTADOS A categoria central foi “A volta para casa: apropriando-se de uma nova realidade”, composta de três subcategorias: apreensão com a nova realidade de cuidados; impacto imediato das mudanças; e implementação do plano de orientações. CONCLUSÃO A transição para o domicílio fez com que os pais tivessem que se adaptar à nova e complexa realidade de cuidados. Melhorias no planejamento e sistematização da primeira alta mostram-se necessárias.

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Health Literacy–Informed Communication to Reduce Discharge Medication Errors in Hospitalized Children

Carroll,

Johnson,

Stassun

et al. 2024

JAMA Netw Open

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ImportanceInadequate communication between caregivers and clinicians at hospital discharge contributes to medication dosing errors in children. Health literacy–informed communication strategies during medication counseling can reduce dosing errors but have not been tested in the pediatric hospital setting.ObjectiveTo test a health literacy–informed communication intervention to decrease liquid medication dosing errors compared with standard counseling in hospitalized children.Design, Setting, and ParticipantsThis parallel, randomized clinical trial was performed from June 22, 2021, to August 20, 2022, at a tertiary care, US children’s hospital. English- and Spanish-speaking caregivers of hospitalized children 6 years or younger prescribed a new, scheduled liquid medication at discharge were included in the analysis.InterventionsPermuted block (n = 4) randomization (1:1) to a health literacy–informed discharge medication communication bundle (n = 99) compared with standard counseling (n = 99). A study team member delivered the intervention consisting of a written, pictogram-based medication instruction sheet, teach back (caregivers state information taught), and demonstration of dosing with show back (caregivers show how they would draw the liquid medication in the syringe).Main Outcome and MeasuresObserved 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. Secondary outcomes included caregiver-reported medication knowledge. Outcome measurements were blinded to participant group assignment.ResultsAmong 198 caregivers randomized (mean [SD] age, 31.4 [6.5] years; 186 women [93.9%]; 36 [18.2%] Hispanic or Latino and 158 [79.8%] White), the primary outcome was available for 151 (76.3%). 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 &lt; .001). Twenty-four 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). 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 &lt; .001). There were no differences in knowledge of medication name, indication, frequency, or storage.Conclusions and RelevanceA health literacy–informed discharge medication communication bundle reduced home liquid medication administration errors and enhanced caregiver medication knowledge compared with standard counseling. Routine use of these standardized strategies can promote patient safety following hospital discharge.Trial RegistrationClinicalTrials.gov Identifier: NCT05143047

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Parental Management of Discharge Instructions: A Systematic Review

Cited by 87 publications

References 96 publications

Video Discharge Instructions for Acute Otitis Media in Children: A Randomized Controlled Open‐label Trial

Video Discharge Instructions for Acute Otitis Media in Children: A Randomized Controlled Open‐label Trial

Transição de cuidados para o domicílio na perspectiva de pais de filhos com leucemia

Health Literacy–Informed Communication to Reduce Discharge Medication Errors in Hospitalized Children

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