Medication Education for Dosing Safety: A Randomized Controlled Trial - 21/10/20
, Carlos A. Camargo, MD, DrPH b, Mohammad Faridi, MPH b, Janice A. Espinola, MPH b, Bryan D. Hayes, PharmD b, c, Stephen Porter, MD, MPH d, e, Ari Cohen, MD b, Margaret Samuels-Kalow, MD, MSHP bAbstract |
Study objective |
This study sought to determine whether a brief intervention at the time of emergency department (ED) discharge can improve safe dosing of liquid acetaminophen and ibuprofen by parents or guardians.
Methods |
We performed a randomized controlled trial in the ED of parents and guardians of children 90 days to 11.9 years of age who were discharged with acetaminophen or ibuprofen, or both. Families were randomized to standard care or a teaching intervention combining lay language, simplified handouts, provision of an unmarked dosing syringe, and teach-back to confirm correct dosing. Participants were called 48 to 72 hours and 5 to 7 days after ED discharge to assess understanding of correct dosing. The primary outcome was defined as parent or guardian report of safe dosing at the time of first follow-up call. Our primary hypothesis was that the intervention would decrease the rate of error from 30% to 10% at 48- to 72-hour follow-up.
Results |
We enrolled 149 of 259 (58%) eligible subjects; 97 of 149 (65%) were reached at first follow-up call, of whom 35 of 97 (36%) received the intervention. Among those participants receiving the intervention, 25 of 35 (71%) were able to identify a safe dose for their child at the time of the first call compared with 28 of 62 (45%) of those in the control arm. The difference in proportions was 26% (95% confidence interval [CI] 7% to 46%). There was a 58% increase in reporting safe dosing in the intervention group compared with the control roup (relative risk 1.58; 95% CI 1.12 to 2.24), and it remained significant after adjustment for health literacy and language (adjusted relative risk 1.50; 95% CI 1.06 to 2.13).
Conclusions |
A multifaceted intervention at the time of ED discharge—consisting of a simplified dosing handout, a teaching session, teach-back, and provision of a standardized dosing device—can improve parents’ knowledge of safe dosing of liquid medications at 48 to 72 hours.
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| Please see page 638 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Kathy N. Shaw, MD, MSCE. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
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| Author contributions: MSK conceived the study and obtained research funding. MSK, CNL, CAC, SP, and BDH participated in study design. MSK, BDH, MCNLL, and AC participated in the conduct of the trial and data collection. MKF, JAE, and MSK performed the data analysis. CNL drafted the initial manuscript. All authors critically reviewed and revised the manuscript. All authors take responsibility for the paper as a whole. |
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| All authors attest to meeting the 4 ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). This work was supported by the Massachusetts General Hospital Department of Emergency Medicine Fellowship Eleanor and Miles Shore 50th Anniversary Fellowship Program for Scholars in Medicine, the National Center for Advancing Translational Sciences, and National Institutes of Health Award UL 1TR002541. The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard Catalyst, Harvard University and its affiliated academic health care centers, or the National Institutes of Health. |
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| Trial registration number: NCT03223246 |
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Vol 76 - N° 5
P. 637-645 - novembre 2020 Retour au numéro
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