Objectives This study aimed to explore the perspectives of children and parents regarding: 1) pediatric patients' knowledge and medication use experiences for chronic conditions; 2) how they want to learn about medicines; and 3) perceptions of community pharmacist–provided counseling. Design Qualitative study using semistructured interviews and thematic analyses. Setting Three community pharmacies in 2 eastern states: one in rural western North Carolina, and 2 in an urban region of western Pennsylvania. Participants A total of 39 study participants: 20 children using medications for chronic conditions and 19 parents interviewed July-December 2015. Main outcome measures Child and parent perspectives regarding pediatric medication use, knowledge, experiences, and pharmacist-provided patient counseling. Results Children and parents had similar perspectives on pediatric medication use and pharmacist counseling experiences. Six themes emerged: 1) child's knowledge, self-management, and medication use experiences; 2) essential medication information and sources; 3) child's frequent absence from the pharmacy; 4) patient counseling needs and recommendations; 5) use of interactive technologies to facilitate learning about medicines; and 6) perceptions of pharmacists. Participants reported that children were independently managing their medications, although they had minimal knowledge about medicines. Children and parents stated that the child's absence during medication pick-up at pharmacies was a barrier to receiving counseling by pharmacists. Children were comfortable and receptive to pharmacists educating them about their medicines, particularly how medications affect the human body, how they were manufactured, and research studies on their medications. Parents and children recommended the use of interactive and educational technologies for pediatric counseling. Conclusion Children are frequently not present at pharmacies during prescription pick-up; however, children and parents are comfortable with and receptive to pediatric medication counseling by pharmacists. Interactive and educational technologies need to be developed and used by pharmacists to facilitate counseling and educate children about the effective and safe use of medicines.

https://cyberleninka.org/article/n/1468974.pdf

Pediatric medication use experiences and patient counseling in community pharmacies: Perspectives of children and parents

ObjectivesMedication errors are hazardous and costly. Children are at increased risk for medication errors because of weight-based dosing, limited FDA indications, and human calculation errors. The aim of this study is to determine the frequency and type of resident prescribing errors in a pediatric

Frequency of prescribing errors by medical residents in various training programs.

Resume Contexte : L’enquete canadienne sur la pharmacie hospitaliere menee tous les deux ans depuis plus de 30 ans aupres des chefs de departement de pharmacie canadiens donne une vision unique et complete de la pharmacie hospitaliere au Canada. Objectif : Presenter la participation du Quebec a l’enquete canadienne sur la pharmacie hospitaliere, en s’appuyant sur les faits ayant marque l’actualite au cours des deux dernieres annees. Methode : Une revue documentaire de l’actualite a ete effectuee. Par la suite, un recensement des faits saillants de l’enquete sur la pharmacie hospitaliere canadienne menee en 2013-2014 aupres des chefs de departements de pharmacie a eu lieu. Les resultats ont ete regroupes selon six thematiques : structure, services, ressources financieres et materielles, ressources humaines, soins et evaluation des pratiques. En troisieme lieu, une comparaison a ete effectuee entre les resultats de l’enquete menee aupres des pharmaciens et les reponses des chefs. Resultats : La periode 2013-2014 a ete marquee par de nombreux evenements et par la publication de plusieurs rapports relatifs a la pratique de la pharmacie hospitaliere. Un total de 170 personnes ont repondu a l’enquete de 2013-2014, dont 45 du Quebec. Sur le plan des services, on constate au Quebec la poursuite de la croissance de la dotation en cabinets decentralises automatises et une contribution plus importante des assistants techniques en pharmacie a la saisie des ordonnances. Au niveau des ressources, les ruptures d’approvisionnements ont mene a des consequences similaires tant pour les sondes canadiens que quebecois. Au Quebec, un nombre plus faible de programmes de soins beneficiaient de la presence decentralisee d’un pharmacien. Le Quebec accusait un retard dans l’evaluation de la prestation de soins directs aux patients, mais se situait avantageusement sur le plan de l’observation de la technique d’aseptisation des assistants techniques. Peu de personnes interrogees etaient au courant des objectifs 2015 de la Societe canadienne des pharmaciens hospitaliers. Conclusion : Cette enquete a permis de suivre la progression de differents indicateurs au fil des annees. Ces indicateurs refletent les effets de certains evenements et rapports. Bien que plusieurs d’entre eux revelent la constante progression des pharmacies hospitalieres quebecoises, il existe un ecart visible par rapport a d’autres regions canadiennes. Abstract Context: The Hospital Pharmacy in Canada Report, conducted in Canada every other year for the past 30 years, surveys pharmacy department directors to provide a unique and complete portrait of hospital pharmacy in Canada. Objective: To present the Quebec-related findings of the Canadian Hospital Pharmacy Survey in light of key developments during the past two years. Method: A literature review of the current situation was carried out. Findings from the Hospital Pharmacy in Canada Report conducted among directors of pharmacy departments in 2013–2014 were then examined. The results were grouped into six different themes: structure, services, financial and physical resources, human resources, care, and evaluation of practices. Survey results from pharmacists and directors of pharmacy departments were then compared. Results: The year 2013–2014 was marked by different events and the publication of a number of articles in hospital pharmacy practice. A total of 170 people responded to the 2013–2014 survey, including 45 in Quebec. In Quebec, in terms of services, there was continued growth in the number of decentralized automated medication dispensing cabinets and an increase in the number of pharmacy technical assistants entering prescriptions in patient files. In terms of resources, stock-outs had similar consequences both for Canadian and Quebec respondents. In Quebec, fewer care programs included the presence of a decentralized pharmacist. Quebec lagged behind in evaluating the delivery of direct patient care but ranked favourably in terms of pharmacy assistants’ aseptic technique compliance. Few respondents were aware of the Canadian Society of Hospital Pharmacists’ 2015 objectives. Conclusion: This survey helps monitor the progression of different indicators over the years. These indicators reflect the impact of certain events and reports. Although a number of them show steady progression in Quebec’s hospital pharmacies, there is a noticeable gap in relation to other Canadian jurisdictions.

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Perspective québécoise et canadienne de la pratique pharmaceutique en établissement de santé 2013-2014

Aims and objective
The objective of this study was to determine parents' experiences and problems with administering medication to their children at home.

Background
Parents' experiences and access to information for the treatment of their children's illnesses at home is necessary for their children's safety.

Design
A descriptive cross-sectional study.

Methods
Four hundred parents from children's hospital outpatient clinics were included. A questionnaire was used to determine parents' experiences and problems with administering medication to their children at home. Descriptive statistical analyses were performed using the spss software package (version 22.00).

Results
Antipyretics (59%) and antibiotics (25%) were the most commonly used medicines by parents without prescription. Nearly half of the parents stated that they gave liquid medicine with a household spoon. It was found that 54% of the parents whose children refused to take tablets or liquid medicine mixed these medications into foods. Treatment was delayed in 20·7% of the children who refused to take tablets and in 29·1% of the children who refused to take liquid medicine. As a result of the project, a form and device were developed as a solution to the problems experienced by parents while administering oral medication in the home environment.

Conclusion
The results of the study showed that a significant percentage of the parents did not use the correct equipment to administer medications, used non-prescription medicines, did not administer medications at correct intervals and mixed medication into foods.

Relevance to clinical practice
Healthcare professionals, especially nurses, should continually evaluate medication administration by parents at home and the readmission rate in the emergency department to further improve children's health.

Administration of oral medication by parents at home.

Evidence suggests that parents and caregivers make frequent errors when administering liquid medications to children. These errors, which include inaccurate dosing as well as non-adherence to medication regimens, place children at risk for morbidity and mortality. The study aim to explore the effectiveness of pictogram based intervention in reducing caregivers’ liquid medication errors as well as the extent to which health literacy impacts medication errors. Quasi-experimental study of caregivers (n=250) of young children (<6 years) enrolled at primary pediatric clinic in Zagazig University hospital. A total of 250 caregivers (121 standard medication counseling and 129 pictogram based intervention) were assessed for health literacy by means of the Newest Vital Sign measure; 84.4%% had low health literacy (Newest Vital Sign score 0-3). Pictogram based intervention recipients were less likely to make errors in knowledge related to medication storage (26.6% vs. 63.3%) dose frequency (20.2% vs. 25%), and preparation compared with caregivers of standard medication counseling recipients (12.8% vs. 31.7%). Pictogram was an efficient way to reduce the prevalence of caregivers' liquid medication errors.

/pdf/a-pictogram-based-intervention-to-reduce-parental-liquid-2nbkan8l6s.pdf

A Pictogram-Based Intervention to Reduce Parental Liquid Medication Errors: Health Literacy Approach

Worldwide, a large number of children are prescribed drugs on an outpatient basis. Medication errors are fairly common in these settings. Though this matter has been well recognized as a cause of concern, limited data is available from ambulatory settings. Medication errors can be defined as errors that may occur at any step, starting from ordering a medication, to dispensing, administration of the drug and the subsequent monitoring. The outcomes of such errors are variable and may range between those that are clinically insignificant to a life-threatening event. The reasons for these medication errors are multi-factorial. Children are unable to administer medications to themselves and also require a strict weight-based dosing regimen. The risk factors associated with medication errors include complex regimens with multiple medications. Overdosing and under-dosing (10-fold calculation errors), an increased or a decreased frequency of dosing or an inappropriate duration of administration of the medication, are frequently detected errors. The lack of availability of proper formulations adds to the confusion. The low level of literacy among the caregivers can aggravate this problem. There is a lack of proper reporting and monitoring mechanisms in most ambulatory settings, hence these errors remain unrecognized and often go unreported. This article summarizes the current available literature on medication errors in ambulatory settings and the possible strategies that can be adopted to reduce the burden of these errors in order to improve child care and patient safety. Voluntary, anonymous reporting can be introduced in the healthcare institutions to determine the incidence of these errors.

Strategies to reduce medication errors in pediatric ambulatory settings

We report an unusual case of massive splenomegaly with pancytopenia without ascites, which was referred to us with suspicion of a myeloproliferative disorder in an adolescent boy. The work-up done was noncontributory to a hematological disorder. On further work-up, liver biopsy depicted sinusoidal congestion, with Doppler study suggestive of nonvisualization of hepatic veins. There was hypertrophy of the right lobe and the presence of venovenous collaterals. Janus kinase 2 (JAK2) V617F mutation was negative, which confirmed the absence of unidentified myeloproliferative disorder. This was an atypical presentation of Budd–Chiari syndrome (BCS) in children. The absence of ascites could be due to more efficient collateral formation in adolescent age groups due to angiogenesis. Underlying thrombophilia was detected as methylenetetrahydrofolate reductase mutation 677C > T with raised serum homocysteine levels. It is imperative to be aware of the diverse clinical manifestations in children for early detection and appropriate intervention to prevent catastrophic results in pediatric BCS.

S Mehndiratta

Papers

Strategies to reduce medication errors in pediatric ambulatory settings

An Unusual Clinical Presentation of Budd–Chiari Syndrome in an Adolescent Boy