Parents’ pain medication underdosing is associated with more emergency department visits in sickle cell disease

Morrison, Andrea K.; Myrvik, Matthew P.; Brousseau, David C.; Drendel, Amy L.; Scott, J. Paul; Visotcky, Alexis

doi:10.1002/pbc.26906

Cited by 11 publications

(16 citation statements)

References 29 publications

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“…The details of the 14 studies are presented in (tables 1 and 2). [15][16][17][18][19][20][21][22][23][24][25][26][27][28] The majority of the included studies were published in the last 12 years. All of the studies (n=14) took place in the USA.…”

Section: Resultsmentioning

confidence: 99%

“… 23 24 While another cross-sectional study looking at parents with child on a short course prescribed medication reported that the majority of the parents measured below the prescribed dose. 15 A study by Morrison et al 20 reported that parents who made underdosing errors made more dosage errors and frequency errors compared with those who made an overdosing error.…”

Section: Resultsmentioning

confidence: 99%

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Literature review of medication administration problems in paediatrics by parent/caregiver and the role of health literacy

Dahmash

Shariff

Kirby

et al. 2020

bmjpo

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ObjectiveTo identify studies that highlighted medication administration problems experienced by parents and children, which also looked at health literacy aspect using a validated tool to assess for literacy.Study designTen electronic databases were systematically searched and supplemented by hand searching through reference lists using the following search terms: (1) paediatric, (2) medication error including dosing error, medication administration error, medication safety and medication optimisation and (3) health literacy.ResultsOf the (1230) records screened, 14 studies were eligible for inclusion. Three analytical themes emerged from the synthesis. The review highlighted that frequencies and magnitudes of dosing errors vary by the measurement tools used, the dose prescribed and by the administration instruction provided. Parent’s sociodemographic, such as health literacy and language, is a key factor to be considered when designing an intervention aimed at averting medication administration errors at home. The review summarised some potential strategies that could help in reducing medication administration errors among children at home. Among these recommendations is to show the prescribed dose to the parents or young people along with the verbal instructions, as well as to match the prescribed dose with the measuring tool dispensed, to provide an explicit dose intervals and pictographic dosing instructions.ConclusionThe findings suggest that in order to optimise medication use by parents, further work is needed to address the nature of these issues at home. Counselling, medication administration instructions and measurement tools are some of the areas in addition to the sociodemographic characteristics of parents and young people that need to be considered when designing any future potential intervention aimed at reducing medication errors among children and young people at home.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Literature review of medication administration problems in paediatrics by parent/caregiver and the role of health literacy

Dahmash

Shariff

Kirby

et al. 2020

bmjpo

View full text Add to dashboard Cite

show abstract

“… 21 The NVS scores range from 0 to 6 and (with lower scores indicating limited HL), and the NVS has been validated in other disciplines 22 and used widely, including for parents who make health decisions for their children. 23 , 24 , 25 Perception of voluntariness was assessed using the Decision-making Control Instrument, a 9-item questionnaire with a Likert scale response format to statements such as “I was powerless in the face of this decision.” 15 Decision-making Control Instrument scores range from 9 to 54 and (with lower scores indicating lower perception of voluntariness) and has been validated for parents who make decisions regarding research therapeutic protocols for serious childhood illnesses, including cancer. 26 Decisional regret was assessed using the Decision Regret Scale, a 5-item questionnaire with a Likert scale, 16 with scores ranging from 0 to 100 (lower scores indicating lower regret), and has been used for parents of children with cancer.…”

Section: Methodsmentioning

confidence: 99%

Assessment of Factors Associated With Parental Perceptions of Voluntary Decisions About Child Participation in Leukemia Clinical Trials

et al. 2021

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Key Points Question Are health literacy, contextual factors, or sociodemographic characteristics associated with parental perception of voluntariness during informed consent for pediatric leukemia clinical trials? Findings In this cross-sectional study that included 97 parents of children with newly diagnosed leukemia, lower perception of voluntariness was significantly associated with lower health literacy. Meaning Low health literacy may have a role in parents not making complete and meaningful informed decisions for their child’s participation in cancer clinical trials.

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“…Since the release of these guidelines, numerous studies have reported delays in the management of sickle cell pain. [11][12][13][14][15] Delays are often due to ED overflow, difficulty obtaining IV access, delayed order placement, assignment of triage levels, etc. 11,12,16,17 Notably, the median time from arrival to initial analgesic administration in pediatric patients with SCD is approximately 90 minutes.…”

Section: Introductionmentioning

confidence: 99%

The association between timely opioid administration and hospitalization in children with sickle cell disease presenting to the emergency department in acute pain

Muslu

Kopetsky²,

Nimmer

et al. 2020

Pediatric Blood & Cancer

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Introduction The National Heart, Lung, and Blood Institute guidelines for sickle cell disease (SCD) pain crisis management recommend opioids within 60 minutes of emergency department (ED) registration and every 30 minutes thereafter until acute pain is managed. These guidelines are based on expert opinion without published, supporting data. Objective To evaluate the association between timely ED opioid administration and hospitalization rates in children with SCD. Methods Retrospective cohort of children presenting to a children's hospital ED with SCD pain between January 1, 2014, and April 30, 2018. Visits were extracted using ICD codes, chief complaints, and receipt of at least one opioid, and then reviewed to confirm the visit was an uncomplicated pain crisis. The primary outcome was hospitalization, yes or no. Generalized estimating equations were used to determine adjusted odds of hospitalization for the timely administration of initial and second doses of opioids. Results Of the 902 eligible visits, 368 (40.8%) resulted in hospitalization. The mean (SD) age was 11.9 (± 5.2) years. The first opioid was administered within 60 minutes of arrival in 601 (66.6%) visits. The second opioid was administered within 30 minutes of the first in 84 (12.3%) visits. Receipt of the first opioid within 60 minutes of arrival was not associated with decreased hospitalization (1.30 [0.96‐1.76]). However, receipt of the second dose within 30 minutes of the first was associated with decreased hospitalization (0.56 [0.33‐0.94]). Conclusion This study suggests an association between children with SCD receiving a second dose within 30 minutes of the first opioid dose and decreased hospitalizations.

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Parents’ pain medication underdosing is associated with more emergency department visits in sickle cell disease

Abstract: For medication knowledge and skills tasks, children of parents who underdosed pain medication had a higher rate of ED visits for pain. Health literate strategies to improve parents' medication skills may improve pain treatment at home and decrease healthcare utilization.

Cited by 11 publications

References 29 publications

Literature review of medication administration problems in paediatrics by parent/caregiver and the role of health literacy

Literature review of medication administration problems in paediatrics by parent/caregiver and the role of health literacy

Assessment of Factors Associated With Parental Perceptions of Voluntary Decisions About Child Participation in Leukemia Clinical Trials

The association between timely opioid administration and hospitalization in children with sickle cell disease presenting to the emergency department in acute pain

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