A Training for Parents Prevents Clinically Relevant Handling Errors in the Use of Long-Term Antiseizure Medication

Abstract

Background Medication handling errors (ME) in long-term antiseizure medication (ASM) compromise patient safety. Training programs to prevent those errors by parents are scarce.

Patients The intervention concept is designed for parents of children and adolescents aged 0–18 years with at least one long-term ASM.

Method In a controlled prospective study, we assessed ME of ASM during home visits 3–6 weeks after a patient’s in- or outpatient hospital visit (outpatient neuropediatric clinic and Social-Pediatric Center (SPZ)). We investigated the effectiveness of a patient specific, risk-adapted training (intervention group, IG) compared to routine care (control group, CG). For 54 ME in ASM handling, an expert panel classified the clinical risk ranging from Score-0 (no risk) to Score-6 (maximum risk) with the lowest risk actually classified as Score-3.

Results We analyzed data from 83 parents in the CG and 85 in the IG who administered 140 ASM per group. The intervention reduced ME per patient from 5 (median; Q25/Q75 3/9) to 4 (2/8; p=0.018). A total number of 589 ME occurred in the CG, 432 in the IG. ME in ASM handling rated Score-6 occurred once in the CG and not in the IG. A relative-risk-reduction (RRR) of ME (with p<0.001) was observed, with a RRR of 55.0% for Score-5, 27.6% for Score-4, and 23.1% for Score-3. RRR was 56.6% for ASM preparation (p<0.001) and 22.4% for oral administration (p=0.045).

Conclusion Compared to controls, ME with high clinical risk significantly decreased in the IG after the training. Drug safety in chronically ill children with ASM was thereby improved.

Zusammenfassung

Hintergrund Medikationsfehler (ME) beim Umgang mit anfallssuppressiver Dauermedikation (ASM) gefährden die Patientensicherheit und Trainingskonzepte zur Fehlerprävention sind rar.

Patienten Das Betreuungskonzept richtet sich an Eltern von Kindern und Jugendlichen von 0–18 Jahren mit mindestens einer ASM in der Dauertherapie.

Methode In einer kontrollierten prospektiven Studie wurden ME im praktischen ASM-Handling bei einem Hausbesuch 3–6 Wochen nach stationärer Entlassung oder Facharztkonsultation (neuropädiatrische Ambulanz und Sozialpädiatrisches Zentrum (SPZ)) erhoben. Wir untersuchten die Wirksamkeit eines patientenspezifischen, risikoadaptierten Trainings (Interventionsgruppe, IG) im Vergleich zur Routineversorgung (Kontrollgruppe, KG). Für 54 ME im praktischen Handling von ASM klassifizierte ein Expertenpanel den klinischen Schweregrad auf einer Skala von Score-0 (kein Risiko) bis Score-6 (maximales Risiko), wobei ein Score von 3 die niedrigste erfolgte Risikoklassifizierung darstellte.

Ergebnisse Wir analysierten Daten von 83 Eltern in der KG und 85 in der IG, die 140 ASM pro Gruppe verabreichten. Das Interventionskonzept reduzierte die begangenen ME signifikant von 5 pro Patient (Median; Q25/Q75 3/9) auf 4 (2/8; p=0.018). Insgesamt traten in der KG 589 ME auf, in der IG 432. Als Score-6 eingestufte ME traten einmal in der KG, in der IG nicht mehr auf. Eine signifikante relative Risikoreduktion (RRR) mit p<0,001 wurde für ME mit Score-5 (RRR=55,0%), Score-4 (RRR=27,6%) und Score-3 (RRR=23,1%) erreicht. ME in der Arzneimittelzubereitung wurden mit einer RRR von 56,6% (p<0.001) und einer RRR von 22,4% (p=0.045) für die orale Applikation signifikant reduziert.

Schlussfolgerung Im Vergleich zur Kontrollgruppe nahmen ME mit hohem klinischem Schweregrad in der IG nach dem Training signifikant ab. Die Patientensicherheit chronisch kranker Kinder mit ASM wurde dadurch verbessert.

Keywords

medication handling error - clinical risk - pediatric - antiseizure medication - training - dummy model

Schlüsselwörter

Medikationsfehler - klinischer Schweregrad - Pädiatrie - anfallssuppressive - Medikation - Training - Dummymodell

• References

• 1 Kaune A, Schumacher PM, Hoppe SC. et al. Administration of anticonvulsive rescue medication in children-discrepancies between parents’ self-reports and limited practical performance. Eur J Pediatr 2016; 175: 1139-1146
• 2 Johannessen Landmark C, Johannessen SI, Patsalos PN. Therapeutic drug monitoring of antiepileptic drugs: current status and future prospects. Expert Opin Drug Metab Toxicol 2020; 16: 227-238
• 3 Jones C, Kaffka J, Missanelli M. et al. Seizure occurrence following nonoptimal anticonvulsant medication management during the transition into the hospital. J Child Neurol 2013; 28: 1250-1258
• 4 Bertsche A, Dahse AJ, Neininger MP. et al. Ambulatory care of children treated with anticonvulsants – pitfalls after discharge from hospital. Klin Padiatr 2013; 225: 277-282
• 5 Lopez-Pineda A, Gonzalez de Dios J, Guilabert Mora M. et al. A systematic review on pediatric medication errors by parents or caregivers at home. Expert Opin Drug Saf 2022; 21: 95-105
• 6 Bertsche T, Niemann D, Mayer Y. et al. Prioritising the prevention of medication handling errors. Pharm World Sci 2008; 30: 907-915
• 7 Niemann D, Bertsche A, Meyrath D. et al. Drug handling in a paediatric intensive care unit–can errors be prevented by a three-step intervention?. Klin Padiatr 2014; 226: 62-67
• 8 Niemann D, Bertsche A, Meyrath D. et al. A prospective three-step intervention study to prevent medication errors in drug handling in paediatric care. J Clin Nurs 2015; 24: 101-114
• 9 Henry Basil J, Premakumar CM, Mhd Ali A. et al. Prevalence, Causes and Severity of Medication Administration Errors in the Neonatal Intensive Care Unit: A Systematic Review and Meta-Analysis. Drug Saf 2022; 45: 1457-1476
• 10 Yin HS, Neuspiel DR, Paul IM. et al. Preventing Home Medication Administration Errors. Pediatrics 2021; 148: e2021054666
• 11 Schumacher PM, Kaune A, Merkenschlager A. et al. Optimizing parents’ performance in anticonvulsant rescue medication administration. Epilepsy Behav 2018; 84: 37-43
• 12 Faul F, Erdfelder E, Lang AG. et al. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 2007; 39: 175-191
• 13 Zahn J, Hoerning A, Trollmann R. et al Manipulation of Medicinal Products for Oral Administration to Paediatric Patients at a German University Hospital: An Observational Study. Pharmaceutics 2020; 12: 583 Erratum in: Pharmaceutics 2021; 24: 13. DOI: 10.3390/pharmaceutics13070939.herziger
• 14 Bates DW, Cullen DJ, Laird N. et al. Incidence of adverse drug events and potential adverse drug events. Implications for prevention. ADE Prevention Study Group. JAMA 1995; 274: 29-34
• 15 Herziger B, Jeschke S, Müller RM. et al. Drug-handling problems and expectations of the ideal pediatric drug – reported by children and their parents. Eur J Pediatr 2022; 181: 2161-2171
• 16 Chew CC, Hss AS, Chan HK. et al. Medication Safety at Home: A Qualitative Study on Caregivers of Chronically Ill Children in Malaysia. Hosp Pharm 2020; 55: 405-411
• 17 Sutherland A, Denham LP, Stephen T. et al. Mapping the prevalence and nature of drug related problems among hospitalized children in the United Kingdom. A systematic review. BMC Pediatr 2019; 19: 486
• 18 Neininger MP, Kaune A, Musiol J. et al. Handling Errors in the Use of Inhalation Devices: Inhalation Technique Skills and Knowledge in Pediatric Nurses. J Nurs Care Qual 2022; 37: 180-187
• 19 Gold JM, Chadwick W, Gustafson M. et al. Parent Perceptions and Experiences Regarding Medication Education at Time of Hospital Discharge for Children With Medical Complexity. Hosp Pediatr 2020; 10: 679-686
• 20 Dahmash DT, Shariff ZB, Kirby DJ. et al. Literature review of medication administration problems in paediatrics by parent/caregiver and the role of health literacy. BMJ Paediatr Open 2020; 4: e000841
• 21 Zimmer J, Niemann D, Seltmann K. et al. Managing of oral medicines in paediatric oncology: can a handbook and a pharmaceutical counselling intervention for patients and their parents prevent knowledge deficits? A pilot study. Eur J Hosp Pharm 2016; 23: 100-105
• 22 Carroll AR, Schlundt D, Bonnet K. et al. Caregiver and Clinician Perspectives on Discharge Medication Counseling: A Qualitative Study. Hosp Pediatr 2023; 13: 325-342
• 23 Jacobs E, Chen AH, Karliner LS. et al. The need for more research on language barriers in health care: a proposed research agenda. Milbank Q 2006; 84: 111-133
• 24 Philips K, Zhou R, Lee DS. et al. Caregiver Medication Management and Understanding After Pediatric Hospital Discharge. Hosp Pediatr 2019; 9: 844-850
• 25 Glick AF, Farkas JS, Nicholson J. et al. Parental Management of Discharge Instructions: A Systematic Review. Pediatrics 2017; 140: e20164165