Helping Parents Medicate Children Safely at Home

A report presented at the annual meeting of the Pediatric Academic Societies calls for more support from medical professionals to ensure the safe administration of “lifesaving” prescription drugs for kids with chronic illnesses.

When faced with the challenge of caring for a chronically ill child, parents quickly learn the importance of support. New research suggests more of it may be needed from pharmacists to help parents avoid serious medication errors when administering drugs at home.

A study presented May 3, 2010 at the Pediatric Academic Societies annual meeting found that parents make frequent mistakes when juggling complex dosing regimens many chronic illnesses require. “Giving these medicines in exactly the right way is vital and sometimes lifesaving for children with chronic conditions,” said lead author Kathleen E. Walsh, MD, MSc.

To determine how often and why such errors occur, Walsh and her colleagues visited the homes of 83 children, aged 6 months to 20 years, who had cancer, sickle cell disease and epilepsy. A total of 544 medications were examined. In addition to watching parents administer the drugs, which researchers were able to do for 166 of the medications, observations included reviewing labels, counting pills, and checking doses. Two physicians were appointed to interpret the errors and evaluate their potential for harm.

Dr. Walsh reported 128 errors, 73 of which were deemed capable of causing harm. Ten errors actually did result in injury. Despite parents’ higher levels of education—37% held bachelor’s degrees and 12% held advanced degrees—mistakes were basic and relatively common.

A total of 24% of the medicines included in the study were affected by errors, which ranged from poor administration technique to grossly inadequate labeling. The study’s authors cited one label for mercaptopurine that read simply “use as directed.” Another methotrexate label called for “6 tabs orally once daily,” instead of the prescribed 7 tablets by mouth once weekly. In some cases, NSAIDS were significantly underdosed; in others, doses failed to reflect physician’s instructions to reduce or increase the amount of medication.

Parents also neglected to take appropriate measures in preparing the medicines, using the wrong syringe to measure liquids or cutting tablets without a pill cutter. Both oversights are easily preventable, yet they resulted in “children getting too little pain medicine or chemotherapy,” said Dr. Walsh.

Although the responsibility of preventing medication errors ultimately resides with the parent, pharmacists can be a tremendous help in managing risk. Previous studies show pharmacists who intervene—by offering extensive counseling, performing checks and double-checks of labels and medication containers, communicating openly with prescribers, and ensuring parents have the proper equipment for delivering medications—can significantly reduce chances of an error occurring.

Even well-educated parents stand to benefit from further instructions on how to safely and accurately manage their child’s daily medication needs, the study concluded. For more information on measures pharmacists can implement to protect children from the consequences of an error, visit the Pharmacy Times medication safety archives.

For other articles in this issue, see:

• Updated Guidelines for Management of Chronic Pain Released
• NCPA’s Jumpstart for Pharmacy Owners
• Study Shows Aspirin Effective for Migraine Pain