Journal of Paediatrics and Child Health, Jun 30, 2021
AimNon‐evidence‐based practice and inappropriate paediatric fever management by care givers is co... more AimNon‐evidence‐based practice and inappropriate paediatric fever management by care givers is common. The aim of this study was to survey a large sample of Australian parents and care givers utilising a validated Fever Management Tool, to determine the current knowledge, beliefs and attitudes of Australian care givers regarding fever management.MethodsThis study employed a cross‐sectional survey conducted via a third‐party market research company. Univariate analysis of demographic factors and their influence on knowledge scores were tested. A multivariate linear regression model was specified using all available independent univariate predicators to determine the demographic factors influencing care givers fever knowledge.ResultsData from 1000 questionnaires were analysed. The participants' total knowledge scores were evenly distributed with a mean score of 15.4/29 correct answers in the True/False questionnaire, a median score of 16 and a standard deviation of 4.27. It highlighted that Australian care givers had poor knowledge in questions related to ‘teething’, ‘physical cooling methods’ and ‘medication dosing’. In the multivariate analysis, 28.9% of the total variance was explained (R2 value = 0.289, P < 0.001) with 5 of 11 factors contributing.ConclusionOverall, this cross‐sectional survey has provided a strong understanding of the current knowledge, attitude and beliefs of Australian care givers in regards to fever management in their children. Total knowledge of fever management was generally poor in Australia with many participants harbouring misconceptions and non‐evidence‐based practices. Future interventions improving fever management practices should be tailored to the specific weaknesses faced by Australian care givers in order to promote long term change.
Journal of Paediatrics and Child Health, Sep 9, 2020
AimThe symptoms of childhood fever are often inappropriately managed by care givers resulting in ... more AimThe symptoms of childhood fever are often inappropriately managed by care givers resulting in overuse of health resources and medication errors. Understanding care giver's knowledge, attitudes and beliefs about fever management using a validated questionnaire is warranted. The aim of this study was to develop and validate a comprehensive Fever Management Questionnaire.MethodsThe questionnaire items were developed through a content analysis of the literature and current fever management guidelines. For the knowledge component, a multidisciplinary panel of 12 experts assessed content validity of items (n = 35) through a one‐round Delphi process. The construct validity of the attitudes and belief items (19 items) were assessed using principal components analysis utilising response data collected from 149 Australian parents and care givers.ResultsBased on the responses from the panel of experts, six items were removed, six items required substantive modification, 13 items required minor modification with the remaining eight items retained in original form. For the Attitudes and Beliefs items, a parsimonious solution with three principal components resulted after removal of six cross‐loading items. The factor loadings of each item displayed a strong correlation to one of three components with scores ranging from 0.791 down to 0.541. The resulting Cronbach's α for the tool was 0.729.ConclusionPsychometric testing of this two‐part Fever Management Questionnaire has resulted in a tool with acceptable validity and reliability. This tool should now be used to gather the knowledge and attitudes of care givers surrounding fever management to further understand factors that lead to inappropriate fever management.
When providing pharmaceutical care to the pediatric population, pharmacists need to take extra ca... more When providing pharmaceutical care to the pediatric population, pharmacists need to take extra care, and be vigilant to try to prevent some of the common drug-related problems that have previously been reported too commonly for this cohort. Through the medication review process (see Chap. 6), pharmacists make recommendations on appropriate dose adjustments, intercept potentially harmful medication errors, determine patient adherence, identify drug-related problems, and take action where necessary such as educating parents and children themselves. Considering that pediatric patients are more likely to experience adverse drug misadventures, they may need a narrower follow-up period than their adult counterparts, and pharmacists are able to apply advanced pharmaceutical and therapeutic knowledge to monitor for adverse, as well as positive outcomes.Some important general principles when treating children should be followed: 1. If the infant is very young (less than 3-6 months), then most often a referral would be appropriate. 2. If the child is very ill (lethargic, listless, and inconsolable), referral is required. 3. If a medication is to be given, then make sure the dose explained to the caregiver is correct (many medicines will be dosed according to weight). 4. Show the caregiver how to effectively administer/use the medication (e.g., show them how to use a syringe for measuring liquid medications). 5. Involve the child (when old enough to take part) in their own care and encourage communication between the child and their parents, because at some stage the child will be responsible for their own medication use.
Background Electronic medication management (eMM) has been shown to reduce medication errors; how... more Background Electronic medication management (eMM) has been shown to reduce medication errors; however, new safety risks have also been introduced that are associated with system use. No research has specifically examined the changes made to eMM systems to mitigate these risks. Objectives To (1) identify system-related medication errors or workflow blocks that were the target of eMM system updates, including the types of medications involved, and (2) describe and classify the system enhancements made to target these risks. Methods In this retrospective qualitative study, documents detailing updates made from November 2014 to December 2019 to an eMM system were reviewed. Medication-related updates were classified according to “rationale for changes” and “changes made to the system.” Results One hundred and seventeen updates, totaling 147 individual changes, were made to the eMM system over the 4-year period. The most frequent reasons for changes being made to the eMM were to prevent medication errors (24% of reasons), optimize workflow (22%), and support “work as done” on paper (16%). The most frequent changes made to the eMM were options added to lists (14% of all changes), extra information made available on the screen (8%), and the wording or phrasing of text modified (8%). Approximately a third of the updates (37%) related to high-risk medications. The reasons for system changes appeared to vary over time, as eMM functionality and use expanded. Conclusion To our knowledge, this is the first study to systematically review and categorize system updates made to overcome new safety risks associated with eMM use. Optimization of eMM is an ongoing process, which changes over time as users become more familiar with the system and use is expanded to more sites. Continuous monitoring of the system is necessary to detect areas for improvement and capitalize on the benefits an electronic system can provide.
Journal of Paediatrics and Child Health, Jun 30, 2021
AimNon‐evidence‐based practice and inappropriate paediatric fever management by care givers is co... more AimNon‐evidence‐based practice and inappropriate paediatric fever management by care givers is common. The aim of this study was to survey a large sample of Australian parents and care givers utilising a validated Fever Management Tool, to determine the current knowledge, beliefs and attitudes of Australian care givers regarding fever management.MethodsThis study employed a cross‐sectional survey conducted via a third‐party market research company. Univariate analysis of demographic factors and their influence on knowledge scores were tested. A multivariate linear regression model was specified using all available independent univariate predicators to determine the demographic factors influencing care givers fever knowledge.ResultsData from 1000 questionnaires were analysed. The participants' total knowledge scores were evenly distributed with a mean score of 15.4/29 correct answers in the True/False questionnaire, a median score of 16 and a standard deviation of 4.27. It highlighted that Australian care givers had poor knowledge in questions related to ‘teething’, ‘physical cooling methods’ and ‘medication dosing’. In the multivariate analysis, 28.9% of the total variance was explained (R2 value = 0.289, P < 0.001) with 5 of 11 factors contributing.ConclusionOverall, this cross‐sectional survey has provided a strong understanding of the current knowledge, attitude and beliefs of Australian care givers in regards to fever management in their children. Total knowledge of fever management was generally poor in Australia with many participants harbouring misconceptions and non‐evidence‐based practices. Future interventions improving fever management practices should be tailored to the specific weaknesses faced by Australian care givers in order to promote long term change.
Journal of Paediatrics and Child Health, Sep 9, 2020
AimThe symptoms of childhood fever are often inappropriately managed by care givers resulting in ... more AimThe symptoms of childhood fever are often inappropriately managed by care givers resulting in overuse of health resources and medication errors. Understanding care giver's knowledge, attitudes and beliefs about fever management using a validated questionnaire is warranted. The aim of this study was to develop and validate a comprehensive Fever Management Questionnaire.MethodsThe questionnaire items were developed through a content analysis of the literature and current fever management guidelines. For the knowledge component, a multidisciplinary panel of 12 experts assessed content validity of items (n = 35) through a one‐round Delphi process. The construct validity of the attitudes and belief items (19 items) were assessed using principal components analysis utilising response data collected from 149 Australian parents and care givers.ResultsBased on the responses from the panel of experts, six items were removed, six items required substantive modification, 13 items required minor modification with the remaining eight items retained in original form. For the Attitudes and Beliefs items, a parsimonious solution with three principal components resulted after removal of six cross‐loading items. The factor loadings of each item displayed a strong correlation to one of three components with scores ranging from 0.791 down to 0.541. The resulting Cronbach's α for the tool was 0.729.ConclusionPsychometric testing of this two‐part Fever Management Questionnaire has resulted in a tool with acceptable validity and reliability. This tool should now be used to gather the knowledge and attitudes of care givers surrounding fever management to further understand factors that lead to inappropriate fever management.
When providing pharmaceutical care to the pediatric population, pharmacists need to take extra ca... more When providing pharmaceutical care to the pediatric population, pharmacists need to take extra care, and be vigilant to try to prevent some of the common drug-related problems that have previously been reported too commonly for this cohort. Through the medication review process (see Chap. 6), pharmacists make recommendations on appropriate dose adjustments, intercept potentially harmful medication errors, determine patient adherence, identify drug-related problems, and take action where necessary such as educating parents and children themselves. Considering that pediatric patients are more likely to experience adverse drug misadventures, they may need a narrower follow-up period than their adult counterparts, and pharmacists are able to apply advanced pharmaceutical and therapeutic knowledge to monitor for adverse, as well as positive outcomes.Some important general principles when treating children should be followed: 1. If the infant is very young (less than 3-6 months), then most often a referral would be appropriate. 2. If the child is very ill (lethargic, listless, and inconsolable), referral is required. 3. If a medication is to be given, then make sure the dose explained to the caregiver is correct (many medicines will be dosed according to weight). 4. Show the caregiver how to effectively administer/use the medication (e.g., show them how to use a syringe for measuring liquid medications). 5. Involve the child (when old enough to take part) in their own care and encourage communication between the child and their parents, because at some stage the child will be responsible for their own medication use.
Background Electronic medication management (eMM) has been shown to reduce medication errors; how... more Background Electronic medication management (eMM) has been shown to reduce medication errors; however, new safety risks have also been introduced that are associated with system use. No research has specifically examined the changes made to eMM systems to mitigate these risks. Objectives To (1) identify system-related medication errors or workflow blocks that were the target of eMM system updates, including the types of medications involved, and (2) describe and classify the system enhancements made to target these risks. Methods In this retrospective qualitative study, documents detailing updates made from November 2014 to December 2019 to an eMM system were reviewed. Medication-related updates were classified according to “rationale for changes” and “changes made to the system.” Results One hundred and seventeen updates, totaling 147 individual changes, were made to the eMM system over the 4-year period. The most frequent reasons for changes being made to the eMM were to prevent medication errors (24% of reasons), optimize workflow (22%), and support “work as done” on paper (16%). The most frequent changes made to the eMM were options added to lists (14% of all changes), extra information made available on the screen (8%), and the wording or phrasing of text modified (8%). Approximately a third of the updates (37%) related to high-risk medications. The reasons for system changes appeared to vary over time, as eMM functionality and use expanded. Conclusion To our knowledge, this is the first study to systematically review and categorize system updates made to overcome new safety risks associated with eMM use. Optimization of eMM is an ongoing process, which changes over time as users become more familiar with the system and use is expanded to more sites. Continuous monitoring of the system is necessary to detect areas for improvement and capitalize on the benefits an electronic system can provide.
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