Journal Article

207 Parent perspectives on medicines safety systems for children in hospital

Hughes, Joanne, Chambers, Joanna, Ridgewell, Heidi, Ashcroft, Darren, Sutherland, Adam, Kafka, Susan

2023

Overview

Objective25% of children in hospital experience harmful medication related problems (MRPs).1 Recent research has shown that medicines management in practice is highly complex.2 3 We report the parent experiences of medication safety for children in English hospitals.MethodAn ethnographic study was conducted in three paediatric units in the North of England. 230 hours of non-participant observation and 19 semi-structured interviews with healthcare professionals and parents were undertaken. Data were analysed using an inductive thematic approach. A family forum of five parents helped interpret the data, facilitated by the lead researcher.ResultsGenerally care was viewed as safe with regards acute medication, but for those patients with routine medication needs four themes emerged in the analysis:Advocacy and AutonomyParents ‘reached in’ to support professionals in their tasks. However, this was in tension with organisational expectations. Professionals would assume responsibility for medication at the point of prescription. Parents would continue to administer medicines to their children until then. This could be some time after admission, and created a chaotic medicines landscape. Medicines were often selected on the basis of organisational preference rather than personal requirements resulting in non-adherence.The parent as an information sourceWhere there was a knowledge gap, parents were invited to support the medication process including monitoring. Notwithstanding this, parental medication information was often validated against inaccurate medical records.Competency and patient-centred careParents were asked to administer medicines; competency was generally assumed. Without parents medicines would not be given ‘on time.’ They also provided an additional check on administration. Notwithstanding this informal role, where parents disagreed with professionals, or expressed concerns about their child’s medicines they were dismissed as ‘hard work.’Communication barriersParents were primarily discouraged from participation in medication processes because organisations could not assure communications of changes in medicines. Where parents were involved in medication errors they were often viewed as a causative factor.ConclusionThis study places the parent voice at the heart of patient safety research. Though no adverse medication events were observed, there is evidence that parents are an important source of resilience in medicines safety. The systems for medication safety in hospital are impossible to deliver without parental involvement.Parents want to be part of the system, rather than passive observers. Research is needed to define the role that parents can contribute, to explore barriers to more parent involvement, and how we can maintain safety for all stakeholders.ReferencesSutherland A, Phipps DL, Tomlin S, Ashcroft DM. Mapping the prevalence and nature of drug related problems among hospitalised children in the United Kingdom: A systematic review. BMC Pediatr.; 2019;19:486.Hawkins SF, Morse JM. Untenable expectations: nurses’ work in the context of medication administration, error, and the organization. Glob Qual Nurs Res. 2022;9:1–17.Sutherland A, Phipps DL, Gill A, Wolffsohn K, Morris S, Ashcroft DM. A work domain analysis of medicines management for hospitalised children. In: Balfe N, Golightly D, editors. Ergon Hum Factors. Birmingham, UK: CIEHF; 2022.

• Publisher: BMJ Publishing Group LTD
• Subject: Children / Competence / Drugs / Ethnography / Hospitals / Information Sources / Interviews / Medical personnel / Medical records / Parent Participation / Parent School Relationship / Parents & parenting / Participant Observation / Patient safety / Patient-centered care / Patients / Pediatrics / Safety / Safety research / Safety systems / Semi Structured Interviews / Thematic Approach