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Parents' understanding of medication at discharge and potential harm in children with medical complexity
Axana Selzer1, Fabian Eibensteiner1, Lukas Kaltenegger1
1Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Comprehensive Center for Pediatrics, Division of Pediatric Nephrology and Gastroenterology, Vienna, Austria.
Insights
Medication misunderstanding is common in children with medical complexity (CMC), leading to potential harm. Targeted communication strategies and improved discharge processes are crucial for patient safety.
Area of Science:
- Pediatric Healthcare
- Patient Safety
- Medication Management
Background:
- Children with medical complexity (CMC) are a vulnerable patient group requiring specialized care.
- Effective medication management and clear communication are critical during hospital discharge for CMC.
- Previous studies highlight challenges in medication understanding among pediatric patients and caregivers.
Purpose of the Study:
- To evaluate the prevalence of medication misunderstanding and potential harm (PH) in CMC at discharge.
- To identify risk factors associated with medication misunderstanding and PH in this population.
- To inform interventions aimed at improving medication safety for CMC.
Main Methods:
- A cross-sectional study was conducted at a tertiary care center.
- 106 CMC and their caregivers were interviewed at discharge using a structured approach.
- Medication understanding and potential harm were assessed using a hybrid methodology.
Main Results:
- 78.3% of CMC experienced at least one medication misunderstanding, with 31.1% facing potential harm (5 severe).
- Factors associated with misunderstanding included a higher number of medications, new prescriptions, and lower educational/language skills.
- Migratory background and new medications significantly increased the relative risk of potential harm.
Conclusions:
- A high prevalence of medication misunderstanding and potential harm exists in CMC, despite continuous care.
- There is a critical need for targeted interventions to enhance medication safety for CMC.
- Stratifying communication strategies and restructuring discharge processes are essential to address 'unknown unknowns' and improve patient safety.
Objective:
Children with medical complexity (CMC) are among the most vulnerable patient groups. This study aimed to evaluate their prevalence and risk factors for medication misunderstanding and potential harm (PH) at discharge.
Design And Setting:
Cross-sectional study at a tertiary care centre.
Study Population:
CMC admitted at Medical University of Vienna between May 2018 and January 2019.
Intervention:
CMC and caregivers underwent a structured interview at discharge; medication understanding and PH for adverse events were assessed by a hybrid approach.
Main Outcome Measures:
Medication misunderstanding rate; PH.
Results:
For 106 included children (median age 9.6 years), a median number of 5.0 (IQR 3.0-8.0) different medications were prescribed. 83 CMC (78.3%) demonstrated at least one misunderstanding, in 33 CMC (31.1%), potential harm was detected, 5 of them severe. Misunderstandings were associated with more medications (r=0.24, p=0.013), new prescriptions (r=0.23, p=0.019), quality of medication-related communication (r=-0.21, p=0.032), low level of education (p=0.013), low language skills (p=0.002) and migratory background (p=0.001). Relative risk of PH was 2.27 times increased (95% CI 1.23 to 4.22) with new medications, 2.14 times increased (95% CI 1.10 to 4.17) with migratory background.
Conclusion:
Despite continuous care at a tertiary care centre and high level of subjective satisfaction, high prevalence of medication misunderstanding with relevant risk for PH was discovered in CMC and their caregivers. This demonstrates the need of interventions to improve patient safety, with stratification of medication-related communication for high-risk groups and a restructured discharge process focusing on detection of misunderstandings ('unknown unknowns').
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