Assessment of parents’ understanding of pediatric medical prescriptions

Assessment of parents’ understanding of pediatric medical prescriptions Dhanani J.1, Dihora R.2, Goti A.3, Shah R.4* DOI: https://doi.org/10.17511/ijpr.2020.i06.08 1 Jatin Dhanani, Assistant Professor, Department of Pharmacology, GMERS Medical College, Valsad, Gujarat, India. 2 Rameshkumar Dihora, Fellowship in Neonatology (IAP), Consultant Neonatologist, NICE Children Hospital, Surat, Gujrat, india. 3 Ashish Goti, Consultant Neonatologist and Pediatric intensivist, NICE Children Hospital, Surat, Gujrat, India. 4* Rima Shah, Assistant Professor, Department of Pharmacology, GMERS Medical College and General Hospital, Gandhinagar, Gujarat, India.

Careful consideration is needed, especially for pediatric patients, as they have less ability to communicate and to understand the implications of taking medicine. They are also more vulnerable to the adverse effects of medicine than adults [5].   Table 3. -zed measuring devices. The accuracy of 5 mL measurements using the dosing cup provided by the investigators was achieved by the majority. This is in contrast to Yin et al [16] who reported that nearly 23.3% of parents (double that in the present study) used non-standardized liquid dosing instruments, and 67.8% were unaware of weight-based dosing [16]. However, Ryu and Lee [14] have reported that the error committed in dosing measurement was only 11.3% and calibrated dosing cup, printed calibrated dosing cup, dosing spoon, dispensing bottle or spoon with bottle adapter were used by caregivers to measure out liquid medicines. Most of the parents properly reconstituted dry powder and used appropriate fluids for reconstitution. They also washed the dosing devices before storing them.
These are also encouraging practices that were encountered.
However, knowledge regarding the duration of storage of reconstituted medicine was not optimum as most of the parents were unable to read the prescription due to poor writing. Although most caregivers could not read and understand the expiry date on the medicine labels and others could rely on their literate partners or family members. Nearly, half the study subjects stopped the medicines once the child got better, instead of following the advice of the physician. This practice can compromise therapeutic outcomes and in the case of antibiotics, foster resistance. This also implies inadequate counseling of the parents or guardians by doctors and other caregivers. It was often found that if children vomited medicines, the mothers resorted to skipping the present dose or feeding the medicine after some time. In an online survey to identify the practices and opinions of pediatricians about redosing of medicines after vomiting, [17]  instructions, and less frequent medication error [16]. In addition, the demonstration of measurement can decrease the rate of medication error [16]. Similar trends were encountered. Thus, such errors can be minimized by the appropriate demonstration of dose measurement by the physician or nursing staff, the use of more accurate devices for measurement, and improvement of the information given to parents on the prescribed medicines.
It was found that more than half of parents were unaware of total instructions with respect to all factors of pediatric prescription which seems to have a major contribution towards medication side effects. Knowledge of prescription is not well imparted in pediatrics and even not well understood by parents of the child but is highlighted by the Agency for Healthcare Research and Quality as an important factor for quality treatment and better healthcare [21]. A pediatric study in the Kingdom of Saudi Arabia revealed that 47% of subjects recognized possible medication side effects due to poor understanding of all factors of prescription [22]. The present study revealed a lower frequency but expands these findings to Indian and primarily minority populations, filling an understudied research gap in the pediatric literature.
The present study has the limitations of being the only hospital-based and of relatively short duration.
Despite this, in conclusion, it can be said that clinicians should be aware that many caregivers still continue potentially wrong practices in measuring and administering liquid medicines to children. Once the knowledge gaps and wrong practices can be identified by spending time over these issues, remedial measures can be implemented, beginning with rapport building between the treating physicians and the caregivers who look after these children and continuing with counseling at every Opportunity. This would contribute to making medicines safer and more effective for sick children.

Conclusion
Pediatric physician's prescriptions are not being completely understood by parents. Pharmacists are unable to follow all the physicians' prescriptions and are too busy to communicate either with the doctor or the patient for the same. Parents are unable to get all the information needed either from the Physician or the pharmacist and this varies with their education levels.
What does the study add to the existing knowledge?
No attempt is made to understand the parent's ability to follow what is conveyed through a prescription. Factors like the age of parents, Child's age, parent occupation, education of parent, experience in administering medicine, number of medicines prescribed, and type of dosage form were significantly impacting parent's understanding regarding medication. Proper communication with parents can serve as a key factor for the betterment of their children.