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

Publication History

Article published online:
27 December 2024

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