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Published on: November 9, 2016
Administration of anticonvulsive rescue medication in children-discrepancies between parents' self-reports and
Almuth Kaune1,2, Pia Madeleine Schumacher1,2, Sabine Christine Hoppe1,2
1Drug Safety Center, Leipzig University and University Hospital of Leipzig, Eilenburger Str. 15a, 04317, Leipzig, Germany.
Insights
Parents frequently make clinically significant errors when administering seizure rescue medication to children, despite reporting no issues. Observed drug-handling errors were common and high-risk, highlighting a critical gap in medication safety for pediatric epilepsy management.
Area of Science:
- Pediatric Neurology
- Pharmacology
- Patient Safety
Background:
- Anticonvulsant rescue medication is recommended for seizures lasting over 5 minutes.
- Parents are the primary administrators of rescue medication to children outside of hospital settings.
- Most parents report no difficulties in administering these medications.
Purpose of the Study:
- To evaluate the quality of parents' performance in administering anticonvulsant rescue medication to children.
- To identify and assess the clinical risk of drug-handling errors made by parents during medication administration.
Main Methods:
- A questionnaire was used to gather parents' self-reported experiences with rescue medication administration.
- Parents administered rescue medications to dummy dolls to assess actual drug-handling errors.
- An expert panel evaluated the clinical risk of identified handling errors on a scale of 1 (lowest) to 6 (highest).
Main Results:
- A high percentage of parents (97%) made at least one handling error during rectal administration, compared to buccal administration (58%).
- All observed errors were rated as high clinical risk (class 4-6) by the expert panel.
- Previous experience with rescue medication did not predict the number of errors committed.
Conclusions:
- Observed drug-handling performances revealed a high frequency of clinically relevant errors by parents.
- Despite frequent errors, most parents self-reported no problems administering rescue medication.
- There is a significant need for improved parental education and support in administering pediatric seizure rescue medications.
Unlabelled:
Quality of parents' performance in administering anticonvulsive rescue medication to their children suffering from seizures is unknown. After obtaining ethical approval, we used a questionnaire to ask parents of children with seizures, who had been prescribed rescue medications, about their experience in administering those. To assess the frequency of actually committed drug-handling errors, we let them administer rescue medications to dummy dolls. An expert panel rated the clinical risk of handling errors from "1" (lowest) to "6" (highest). Eighty-one parents completed the study. In the questionnaire, 85 % (100 %) of parents that already conducted rectal (buccal) administration reported that they had never experienced problems. The number of rectal administrations with at least one handling error (97 %, 58/60) was higher than in buccal administration (58 %; 14/24; p < 0.001). According to logistic regressions, previous use of rescue medication was not a predictor of the number of committed errors per process (n. s.). All errors were rated with a high clinical risk (class 4-6).
Conclusion:
By observing parents' administration of rescue medication to dummy dolls, we found a high frequency of clinically relevant drug-handling errors. Most parents, however, self-reported to have never experienced problems while administering rescue medications to their children.
What Is Known:
• For seizures with duration of more than 5 min, the administration of anticonvulsive rescue medication is recommended. • Outside the hospital, the administration of rescue medication to children is performed most frequently by their parents. What is New: • Most of the parents reported that they had never experienced problems in handling anticonvulsive rescue medication. • But in the observed drug-handling performances, identified errors committed by parents were alarmingly frequent and pose a high clinical risk according to an expert panel.
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