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Improving Caregiver Understanding of Liquid Acetaminophen Administration at Primary Care Visits
Sean M Cullen1, Snezana Nena Osorio1, Erika A Abramson1,2
1Departments of Pediatrics.
Insights
Caregiver education on liquid acetaminophen dosing significantly improved through quality improvement initiatives. Implementing pictograms and oral syringes enhanced understanding of pediatric medication administration.
Area of Science:
- Pediatric Quality Improvement
- Medication Safety
- Health Literacy
Background:
- Liquid medication dosing errors are prevalent in pediatric care, highlighting critical gaps in caregiver education.
- A 2015 American Academy of Pediatrics policy statement underscored the need for improved prescribing and administration practices for liquid medications.
Purpose of the Study:
- To enhance caregiver comprehension of liquid acetaminophen administration, focusing on key components: name, indication, dose, and frequency.
- To increase the percentage of caregivers with adequate understanding from 30% to 70% within a 32-month timeframe during 2-month well-child visits.
Main Methods:
- A resident-led, interdisciplinary quality improvement team implemented sequential interventions.
- Caregiver understanding was assessed via a 4-item verbal questionnaire; adequate understanding required correct answers to all items.
- Data analysis utilized Shewhart "P" charts, and scatter plots examined the correlation between syringe provision and caregiver understanding.
Main Results:
- Overall caregiver understanding of liquid medication use increased from 39.8% to 74% among 636 participants.
- Knowledge of accurate dosage administration improved substantially, rising from 50.9% to 76.8%.
- A strong positive correlation (R = .84) was observed between the provision of oral syringes and improved caregiver understanding.
Conclusions:
- Resident-led quality improvement initiatives effectively enhanced caregiver understanding of liquid acetaminophen administration in infants.
- Key interventions included the implementation of bilingual pictograms (English and Spanish) and the use of dose-demarcated oral syringes combined with teach-back methods.
- Future research will explore the generalizability of these interventions to other medications and their expansion to different clinical services.
Objectives:
Liquid medication dosing errors are common in pediatrics. Our outpatient clinic identified gaps in caregiver education based on a 2015 American Academy of Pediatrics policy statement on prescribing liquid medications. This quality improvement (QI) initiative sought to improve caregiver's understanding of liquid acetaminophen administration at the 2-month well-child visit from 30% to 70% over a 32-month period.
Methods:
A resident-led interdisciplinary QI team performed sequential interventions to improve our outcome measure: the percentage of caregivers with an adequate understanding of 4 essential components of liquid acetaminophen administration (name, indication, dose, and frequency). Outcome data were collected via a 4-item verbal assessment of caregiver's understanding by nursing staff, with correct answers to all items considered adequate understanding. Process measures (medications prescribed and education provided), and balancing measures (anticipatory guidance items discussed) were gathered via electronic health record review. Shewhart "P" charts and established rules for detecting special cause variation were used to analyze data. Scatter plots assessed the association between the provision of syringes and caregiver understanding of medication administration.
Results:
In 636 caregivers, overall understanding of medication use improved from 39.8% to 74%. Knowledge of accurate dosage improved from 50.9% to 76.8%. Correlation between syringe provision and caregiver understanding was strong (R = .84).
Conclusions:
Resident-led QI improved caregiver's understanding of liquid acetaminophen administration in infants. The most impactful interventions were implementation of English and Spanish pictograms and provision of dose-demarcated oral syringes, coupled with teach-back. Future interventions will examine generalizability to other medications and expansion to other services.
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