Naureckas Li Caitlin, Camargo Carlos A, Faridi Mohammad, Espinola Janice A, Hayes Bryan D, Porter Stephen, Cohen Ari, Samuels-Kalow Margaret
Division of Pediatric Infectious Diseases, Boston Children's Hospital, Boston, MA.
Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA.
Ann Emerg Med. 2020 Nov;76(5):637-645. doi: 10.1016/j.annemergmed.2020.07.007. Epub 2020 Aug 15.
This study sought to determine whether a brief intervention at the time of emergency department (ED) discharge can improve safe dosing of liquid acetaminophen and ibuprofen by parents or guardians.
We performed a randomized controlled trial in the ED of parents and guardians of children 90 days to 11.9 years of age who were discharged with acetaminophen or ibuprofen, or both. Families were randomized to standard care or a teaching intervention combining lay language, simplified handouts, provision of an unmarked dosing syringe, and teach-back to confirm correct dosing. Participants were called 48 to 72 hours and 5 to 7 days after ED discharge to assess understanding of correct dosing. The primary outcome was defined as parent or guardian report of safe dosing at the time of first follow-up call. Our primary hypothesis was that the intervention would decrease the rate of error from 30% to 10% at 48- to 72-hour follow-up.
We enrolled 149 of 259 (58%) eligible subjects; 97 of 149 (65%) were reached at first follow-up call, of whom 35 of 97 (36%) received the intervention. Among those participants receiving the intervention, 25 of 35 (71%) were able to identify a safe dose for their child at the time of the first call compared with 28 of 62 (45%) of those in the control arm. The difference in proportions was 26% (95% confidence interval [CI] 7% to 46%). There was a 58% increase in reporting safe dosing in the intervention group compared with the control roup (relative risk 1.58; 95% CI 1.12 to 2.24), and it remained significant after adjustment for health literacy and language (adjusted relative risk 1.50; 95% CI 1.06 to 2.13).
A multifaceted intervention at the time of ED discharge-consisting of a simplified dosing handout, a teaching session, teach-back, and provision of a standardized dosing device-can improve parents' knowledge of safe dosing of liquid medications at 48 to 72 hours.
本研究旨在确定在急诊科（ED）出院时进行简短干预是否能提高家长或监护人对液体对乙酰氨基酚和布洛芬的安全给药能力。
我们在急诊科对年龄在90天至11.9岁、出院时带对乙酰氨基酚或布洛芬或两者的儿童的家长和监护人进行了一项随机对照试验。家庭被随机分为接受标准护理或接受一项教学干预，该干预包括通俗易懂的语言、简化的资料、提供一支无标记的给药注射器以及通过反馈教学来确认正确给药。在急诊科出院后48至72小时以及5至7天给参与者打电话，以评估他们对正确给药的理解。主要结局定义为首次随访电话时家长或监护人报告的安全给药情况。我们的主要假设是，在48至72小时的随访中，干预措施将使错误率从30%降至10%。
我们纳入了259名符合条件的受试者中的149名（58%）；在首次随访电话中联系到了149名中的97名（65%），其中97名中的35名（36%）接受了干预。在接受干预的那些参与者中，首次电话随访时35名中的25名（71%）能够为其孩子确定安全剂量，而对照组62名中的28名（45%）能做到。比例差异为26%（95%置信区间[CI] 7%至46%）。与对照组相比，干预组报告安全给药的比例增加了58%（相对风险1.58；95% CI 1.12至2.24），在对健康素养和语言进行调整后仍具有显著性（调整后的相对风险1.50；95% CI 1.06至2.13）。
在急诊科出院时进行的多方面干预——包括简化的给药资料、教学课程、反馈教学以及提供标准化给药装置——可以在48至72小时内提高家长对液体药物安全给药的知识水平。
