Soins complexes à domicile pour enfants
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Medication safety

You may have already realized that your child is at risk of medication errors, more than the general population of children. These errors can happen in all care settings: at home, at school, in the hospital and anywhere else that  medication is given. Parents play a critical role in the prevention of medication errors. The first step is to be aware of the risk and what you can do to reduce it.

Medication safety is a team effort, involving all of the different people involved in your child’s care; tips are provided here to help you do your part.

How to reduce your child’s risks of a medication error

Children with medical complexity have multiple reasons to be at increased risk of medication errors. The good news is that you can significantly reduce the risk of error in many ways. Follow these tips to optimize your child’s safety.

  1. Know your child’s medications
  2. Keep an up-to-date list of all of your child’s medications, readily available
  3. Know your child’s medication by dose not only by volume
  4. Use a medication log to keep track of what medications are given and when
  5. Keep a written record of allergies and any previous adverse reactions to medications
  6. Use a single community pharmacy; get to know your local pharmacist
  7. Ask your child’s healthcare team if the number of medications can be reduced or if any medication can be given less often
  8. Be aware of high risk situations for medication errors
  9. Speak up if you think that your child is being given the wrong medication or dose
  10. Store medication safely at home
  11. Practical Do’s and Don’ts for storage and administration
  12. Tips on giving medication to children


Know your child’s medications

You should know the names of all of your child’s medications. Medications usually have two names: a general/generic name and also a trade/commercial name. Many medications have complicated names; don’t hesitate to ask your pharmacist or your child’s healthcare team to clarify or spell any medications. Whenever a new medication is prescribed to your child ask these questions:

Why does my child need this medicine? For what reason is it being prescribed?

What is the exact name of the medication?

How does it work (eg, protects the stomach from irritation and inflammation)?

How much of the medication does my child need?

What are the important side effects of this medication (that is, common side effects and very serious side effects)?

Will this new medication interact with any of the medications that my child is already taking?

How much does this medication cost?

Are there any special instructions for how I should give this medication to my child?

This sounds like a lot of information – because it is! Most parents would find it very challenging to remember all of this information, especially when they are already very busy providing daily care to their child. It is usually less stressful to keep this information in a written format, so that you can re-read it whenever you need to.

We strongly recommend the following:

Ask for written information on each medication – pharmacists and healthcare professionals have access to many medication summary documents that have been created exactly for this purpose.

Keep a copy of the medication information in your child’s care organizer or in a reference binder at home.

Ask questions when you do not know exactly why your child is taking a specific medication.

Whenever a new medication is prescribed, make sure that the prescriber knows all of the other medications that your child takes.


Keep an up-to-date list of all of your child’s medications, readily available

This list is one of the most important documents for your child, especially in an emergency situation. For each medication, the list should include:

Name of medication

Exact dose (if it is a liquid, include both the mg and the ml)

Frequency (how often it is give, for example, twice a day)

How it is given (for example: by mouth, by inhalation, through a gastrostomy tube)

You can make your own list or use a template. Your child’s healthcare team may have a template to share with you. Keep a copy in your child’s care organizer. Take a photo of the list and keep it on your cellphone. Some pharmacies will print this list out for you; if all of your child’s medications are from one pharmacy, this is an easy way to always have an up-to-date list.


Know your child’s medication by dose not only by volume

Many children take medication in liquid form. This means that there is a certain dose in a certain volume, for example 5 mg per 1 ml. This is called the concentration of the medication. Medication can be made in many different concentrations, within one pharmacy and between pharmacies. When you are not aware of a change in the concentration of a medication, you may inadvertently give your child too much or too little of the actual dose in mg. Unfortunately, this is a common type of medication error in children with medical complexity. To prevent this type of error in your child:

Be aware of the dose of medication in mg

Know the concentration of liquid medicine

Check the label, especially when medication is refilled or newly prescribed, to verify your child’s dose (mg) AND volume (ml)


Use a medication log to keep track of medication administration

A medication log is the best way to track your child’s medications and can help avoid missed doses or unintended duplication of doses. It is especially important when there are different people giving the medications to your child. You can make your own medication log or use a template. Your child’s healthcare team may have a template to share with you. The log should include:

Name of medication

Dose of the medication (if it is a liquid, include mg and the ml)

Columns to show the times that the medication is given (leave a space for a check mark or initials, to indicate that the medication was given, and who gave it (if needed)


Keep a written record of allergies and any previous adverse reactions of medications

Keep a written record, in your child’s care organizer, for any allergies, intolerances or previous adverse reactions to any medication. This can be life-saving information – it is important that you know the specific details. Take a photo of the record for easy access on your cellphone. Make sure that these allergies, intolerances or previous adverse reactions are clearly communicated whenever your child is in someone else’s care (eg, a babysitter) or in another care setting (for example, staying at a respite centre or when admitted to the hospital).


Use a single community pharmacy; get to know your local pharmacist

By using a single community pharmacy, all your child’s medications will be dispensed from a single site. This allows the pharmacist to recognize errors, such as potential drug interactions or errors in dosages. The pharmacist may have additional helpful information for you regarding your child’s medications. When you use many different pharmacies, there may be important differences in how liquid medications are prepared. For example, one pharmacy may make a medication that is 5 mg per ml and another pharmacy might make the same medication in a liquid that has 1 mg per ml. If you are only thinking about how many ml of the medication you are giving, there could be a serious over  or under dosing of the medicine. This is one of the most common types of medication errors that children with liquid medications can have.


Ask your child’s healthcare team if the number of medications can be reduced or if any medication can be given less often

Polypharmacy, or taking multiple medications, is one of the biggest risk factors for medication errors. On a regular basis, review your child’s medications with the healthcare team. Ask your child’s doctor if any medications can be decreased or stopped – this may not be possible but it is worth checking. Always follow the advice of your child’s healthcare team.


Beware of high risk situations for medication errors

While everyday vigilance is key to medication safety, there are times when the risk is higher than usual. Medication errors occur more commonly when a child is moving between care settings, for example, when the child is admitted to or discharged from the hospital. Changes in the following areas also increase the risk of errors:

The person giving the medication (for example, a new caregiver who is less familiar with your child)

The dose of the medication

The frequency of the medication (for example, a medication that was given twice daily before and has been changed to once a day)


Speak up if you think that your child is being given the wrong medication

There is no room for shyness when it comes to your child’s safety. Use respectful communication if you believe that your child is getting the wrong medication. Do not be afraid to speak up on behalf of your child.


Store medications safely at home

It is important to keep medications safely stored at home, especially if there are other children in the home. Keep medications for other family members in a separate location so that there is no confusion. As much as possible, medications should be kept in a locked, secure cabinet. If the required medications require refrigeration, consider installing a locked drawer or reserving one shelf for a locked box to store medication. If possible, consider the purchase of a separate, lockable mini-refrigerator. Talk with your child’s healthcare team and/or pharmacist to learn more about the safe storage of the specific medications that your child is taking.


Practical Do’s and Don’ts for storage and administration

Medications can be damaged by heat, air, light and moisture.

Exposure of medication to inappropriate conditions and use past expiry date  may render them ineffective or even harmful if ingested.

Being diligent about storing your medication safely and appropriately will help protect the health of your child and those around you.

DO

Always store medication out of the sight and reach of children and pets to prevent accidental ingestion.

Always follow recommended storage. If in doubt, ask your pharmacist.

Keep medication in the original container with label, directions and expiry dates.

Store medication safely in a cool dry place such as a locked drawer, a closet, a storage box, a shelf.

DON’T

Put or combine medication in unlabelled containers.

Store medications in the bathroom medicine cabinet since heat and moisture (shower, bath, sink) may damage your medicine.

Store medications in the kitchen since heat (stove, sink, appliances) can also damage medication.

Leave medication in a car for any length of time.

Tips on giving medication to children

Giving medications by nasogastric tube

Find detailed information in the section Enteral Nutrition

Giving medications by gastrostomy tube

Find detailed information in the section Enteral Nutrition

Giving medications by mouth

Adolescents

  • Ideally, adolescents are becoming more responsible for their own health, including taking medications.
  • Unfortunately it is also a time when many teenagers skip or stop taking medications; if you suspect that this might be happening, talk to your healthcare team immediately.
  • Use the strategies listed for older school aged children, gradually decreasing your direct supervision when you see that your adolescent is behaving responsibly.
  • Make your expectations clear to your adolescent (and realistic, based on their capabilities).
  • Encourage your adolescent to use routine and reminders, such as a special ring on a cellphone.
  • Use the tools that your adolescent prefers, such as texting, for reminders. Try to phase out the reminders gradually. This will support your adolescent’s transition towards autonomy.
  • Reward positive behaviours with positive praise and privileges.

https://complexcareathomeforchildren.com/prepare-yourself/medication-safety/

Disclaimer: As medical and technical knowledge is constantly changing, this information is provided to you for educational purposes only. The information provided on this website is strictly provided on an “as is” basis without warranty of any kind, whether express or implied and should not at any time be considered as a substitute for professional advice from your physician or other qualified healthcare professional.

A collaboration of clinical experts across Quebec has taken every care to ensure that the information contained in this document is accurate, complete, and reflective of evidence-based practices. However, “Complex care at home for children” collaboration cannot and does not assume any responsibility for application of the content of this document or for any information that may be present in the websites cited as a reference. These web sites are provided for informational purposes only and do not represent the collaboration endorsement of any companies or products. Always consult your child’s physician and/or a qualified healthcare professional to learn more about recommendations specific to your child’s health needs.

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