Loading [MathJax]/jax/output/HTML-CSS/fonts/TeX/fontdata.js

Journal List > Korean J Adult Nurs > v.29(4) > 1096345

TOOLS
Bae and Shin: Effects of Skill Teaching of Oral Administration for Caregivers of Hospitalized Toddler on Dose Loss and Administration Behavior
Original Article

Korean J Adult Nurs 2017;29(4):333-342.

Published online: 9 August 2017

DOI: https://doi.org/10.7475/kjan.2017.29.4.333

Effects of Skill Teaching of Oral Administration for Caregivers of Hospitalized Toddler on Dose Loss and Administration Behavior

Mi-Jeong Bae, MSN, APN1, Nah-Mee Shin, Ph.D., APRN-ACNP, BC2,

1Dongguk University Ilsan Hospital, Ilsan, Korea

2College of Nursing, Korea University, Seoul, Korea

Corresponding author: Shin, Nah-Mee College of Nursing, Korea University, 145 Anam-ro, Sungbuk-gu, Seoul 02841, Korea. Tel: +82-2-3290-4924, Fax: +82-2-928-9108, E-mail: nshin@korea.ac.kr

- This manuscript is a revision of the first author's master's thesis from Korea University.

Received 28 March 201721 June 2017       Accepted 1 August 2017

Copyright © 2017 Korean Society of Adult Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study was designed to assess the effects of skill teaching of oral liquid medication on the dose loss and caregivers' administering behavior.

Methods

A nonequivalent control group no-synchronized design was used. 104 participants were assigned to one of two groups. A intervention group received a skill teaching and the control group received the conventional teaching about oral medication.

Results

The mean amount of the dose loss by all participating caregivers was 23.3% of the prescribed dose and 61.5% of the caregivers showed dose loss more than 20% of the prescribed dose. Caregivers' age (Exp=3.56, p=.017) and time taken for administration (Exp=7.97, p<.001) were related to more dose loss. Toddlers' posture sitting in a stroller upon medication (Exp=.14, p=.009) and re-administering the remains after checking the medication bottle (Exp=.22, p=.040) influenced on reduction in dose loss. Before and after the skill teaching, a significant decrease in the dose loss was found in the high-viscous liquid medication only (t=-4.95, p<.001). The difference in the dose loss between the two groups were significant in the high-viscous liquid medication (t=4.95, p<.001). Also, caregivers' administration behavior were significantly improved in the intervention group.

Conclusion

The findings of this study showed that the skill teaching of oral liquid medication designed for toddlers' caregivers was effective in reduction of dose loss and improvement in administering behaviors with confidence.

Go to : Goto

Keywords: Caregivers, Oral administration, Teaching, Behavior

REFERENCES

1. Hockenberry MJ, Wilson D. Wong's essentials of pediatric nursing. 3th. ed.Jo KJ, Song JH, You IY, Park IS, Park ES, Kim MW, editors. translator.USA: Elsevier Science Health Science div;2012. p. 511.
2. Lajoinie A, Henin E, Kassai B. Oral formulation of choice for children. Archives de pediatrie: Organe Officiel de la Societe Francaise de Pediatrie. 2015; 22(8):877–85. https://doi.org/10.1016/j.arcped.2015.05.012.
3. Madlom-Kay DJ, Mosch FS. Liquid medication dosing errors. Journal of Family Practice. 2000; 49(8):741–4.
4. Sobhani P, Christopherson J, Ambrose PJ, Corelli RL. Accuracy of oral liquid measuring devices: comparison of dosing cup and oral dosing syringe. Annals of Pharmacotherapy. 2008; 42(1):46–52. https://doi.org/10.1345/aph.1K420.
crossref
5. Peacock G, Parnapy S, Raynor S, Wetmore S. Accuracy and precision of manufacturer -supplied liquid medication administration devices before and after patient education. Journal of the American Pharmacists Association. 2010; 50(1):84–6.
6. Ryu GS, Lee YJ. Analysis of liquid medication dose errors made by patients and caregivers using alternative measuring devices. Journal of Managed Care & Speciality Pharmacy. 2012; 18(6):439–45. https://doi.org/10.18553/jmcp.2012.18.6.439.
crossref
7. Galt KA, Paschal KA. Foundations in patient safety for health professionals. 1st ed. USA:. 2009.
8. Silbey RJ, Alberty RA, Bawendi MG. Physical chemistry. 4th ed.NJ: John Wiley & Sons: Hoboken.;2004. p. 44–5.
9. Chan HK, Hassali MA, Lim CJ, Saleem F, Tan WL. Using pic-tograms to assist caregivers in liquid medication administration: a systematic review. Journal of Clinical Pharmacy and Therapeutics. 2015; 40(3):266–72. https://doi.org/10.1111/jcpt.12272.
crossref
10. Yin HS, Mendelsohn AL, Fierman A, van Schaick L, Bazan IS, Dreyer BP. Use of a pictographic diagram to decrease parent dosing errors with infant acetaminophen: a health literacy perspective. Academic Pediatrics. 2011; 11(1):50–7. https://doi.org/10.1016/j.acap.2010.12.007.
crossref
11. Gonzales K. Medication administration errors and the pediatric population: a systematic search of the literature. Journal of Pediatric Nursing. 2010; 25(6):555–65. https://doi.org/10.1016/j.pedn.2010.04.002.
crossref
12. Agresti A. Categorical data analysis. 3rd ed.Hoboken, NJ: Wiley-Interscience;2012.
13. Simon HK, Weinkle DA. Over-the-counter medications: do parents give what they intend to give? Archives of Pediatrics & Adolescent Medicine. 1997; 151(7):654–6. https://doi.org/10.1001/archpedi.1997.02170440016003.
14. Goldman RD, Scolnik D. Underdosing of acetaminophen by parents and emergency department utilization. Pediatric Emergency Care. 2004; 20(2):89–93.
crossref
15. Yin HS, Dreyer BP, van Schaick L, Foltin GL, Dinglas C, Mendelsohn AL. Randomized controlled trial of a pictogram-based intervention to reduce liquid medication dosing errors and improve adherence among caregivers of young children. Archives of Pediatrics & Adolescent Medicine. 2008; 162(9):814–22. https://doi.org/10.1001/archpedi.162.9.814.
crossref
Go to : Goto

kjan-29-333f1.tif
Figure 1.
Flow chart of study process.
undefined
Table 1.
Homogeneity Test for General Characteristics between Two Group (N=104)
Characteristics Categories Intervention group (n=51) Control group (n=53) χ² or t p
n (%) or M± SD n (%) or M± SD
Child Age (month) 12~23 25 (49.0) 26 (49.1) 1.06† .594
24~35 18 (35.3) 15 (28.3)
36~47 8 (15.7) 12 (22.6)
25.27±9.64 25.76±10.88 0.24 .322
Gender Male 29 (56.9) 30 (56.6) 0.00 ＞.999
Female 22 (43.1) 23 (43.4)
Height (cm) ＜ Average 14 (27.4) 12 (22.6) 2.39 .335
Average 8 (15.7) 15 (28.4)
＞ Average 29 (56.9) 26 (49.0)
88.28±7.75 87.59±9.86 -0.39 .149
Weight (kg) ＜ Average 15 (29.4) 17 (32.1) 0.35† .098
Average 22 (43.1) 20 (37.7)
＞ Average 14 (27.5) 16 (30.2)
12.57±2.42 12.42±2.81 -0.30 .544
Sibling Alone 25 (49.0) 30 (56.6) 0.60 .556
Any 26 (51.0) 23 (43.4)
Hospital stay 1 day 19 (37.3) 14 (26.4) 3.13† .228
2 days 20 (39.2) 30 (56.6)
≥3 days 12 (23.5) 9 (17.0)
Hospitalization Once 30 (58.8) 29 (54.7) 0.38† .884
Twice 16 (31.4) 17 (32.1)
≥3 times 5 (9.8) 7 (13.2)
Types of hospital room (beds) 5 42 (82.3) 34 (64.2) 4.41† .088
2 8 (15.7) 17 (32.0)
1 1 (2.0) 2 (3.8)
Usual swallowing of medication Failed (spitting) 10 (19.6) 14 (26.4) 1.88† .426
Forced 16 (31.4) 20 (37.7)
Easy 25 (49.0) 19 (35.9)
Child's cooperation upon medication Bad 12 (23.5) 16 (30.2) 1.39† .544
Moderate 15 (29.4) 18 (34.0)
Good 24 (47.1) 19 (35.8)
Caregivers Age (year) ≤30 11 (21.6) 14 (26.4) 0.69† .751
31~40 30 (58.8) 27 (51.0)
≥41 10 (19.6) 12 (22.6)
Relationship to child Mother 38 (74.5) 39 (73.6) 3.05† .415
Father 4 (7.9) 9 (17.0)
Grandmother 7 (13.7) 4 (7.5)
Other 2 (3.9) 1 (1.9)
Education level completed ≤ Elementary school 1 (2.0) 2 (3.8) 1.94† .644
≤ Junior high school 5 (9.8) 3 (5.7)
≤ High school 9 (17.6) 6 (11.3)
≥ College 36 (70.6) 42 (79.2)
Religion Yes 20 (39.2) 18 (34.0) 0.31 .684
No 31 (60.8) 35 (66.0)
Experience of medication Yes 47 (92.2) 48 (90.6) 0.08 ＞.999
No 4 (7.8) 5 (9.4)
Dose loss (%) Medication type based on liquid viscosity High: Acetaminophen 24.19±11.69 22.40±8.19 -0.90 .369
Low: Levodropropizine e 5.94±6.74 8.22±6.94 1.69 .903

† Fisher's exact test.

Table 2.
Influence of Caregivers' Characteristics and Administering Behaviors on Dose Loss (N=104)
Characteristics Categories B p Exp (B) 95% CI for Exp (B)
Lower limit Upper limit
Child Height by age (month)(standard: Under average) -0.58 .081 0.55 0.28 1.07
Caregivers Age (year)(standard: Below 30) 1.27 .017 3.56 1.25 10.12
Caregivers' administering behaviors Information provided (standard: No) 0.91 .085 2.49 0.88 7.07
Administration posture: lying on bed (standard: Other) -1.15 .186 0.31 0.05 1.75
Administration posture: in a stroller -1.95 .009 0.14 0.03 0.60
Body part restrained: arm and trunk (standard: other) -1.17 .078 0.30 0.08 1.14
Time spent on administration (standard: within 1 minute) 2.07 ＜.001 7.97 2.51 25.29
No checking on remains of medication -0.83 .180 0.43 0.12 1.46
Re-administration (standard: no checking on remains of medication) -1.44 .040 0.22 0.05 0.93
Confidence in behavior of medication (standard: no) -0.66 .099 0.51 0.23 1.13

CI=confidence interval.

Table 3.
Differences in Dose Loss before and after Skill Demonstration of Medication
Type of liquid medications Groups Pretest Posttest Pre-Post t p
M± SD M± SD M± SD
High-viscosity: acetaminophen Intervention group (n=42) 23.25±10.41 16.17±6.77 -7.66±9.26 4.95 ＜.001
Control group (n=42) 23.25±8.47 20.96±8.75 -1.19±7.81
Low-viscosity: levodropropizine Intervention group (n=48) 6.00±6.90 4.39±5.59 -1.63±4.12 0.22 .830
Control group (n=48) 7.11±5.78 8.51±7.00 0.75±5.46
Table 4.
Differences in Administering Behaviors before and after Medication Skill Demonstration (N=104)
Variables Categories Intervention group (n=51) Control group (n=53)
Pretest Posttest x2 p† Pretest Posttest x2 p†
n (%) n (%) n (%) n (%)
Information provided No 26 (51.0) 2 (3.9) ＜.001 19 (35.8) 19 (35.8) .577
Verbally 25 (49.0) 49 (96.1) 34 (64.2) 34 (64.2)
Administration posture Lying on bed 8 (15.7) 3 (5.9) 13.00 .163 5 (9.4) 4 (7.5) 7.33 .395
In arms 15 (29.4) 22 (43.1) 20 (37.7) 23 (43.4)
In a stroller 9 (17.6) 8 (15.7) 7 (13.2) 5 (9.4)
Sitting on bed 17 (33.3) 15 (29.4) 15 (28.3) 19 (35.8)
Standing on bed 0 (0.0) 2 (3.9) 4 (7.5) 2 (3.8)
Other (on the floor) 2 (3.9) 1 (2.0) 2 (3.8) 0 (0.0)
Body part restrained None 13 (25.5) 18 (41.2) 11.00 .202 13 (24.5) 18 (34.0) 6.33 .387
Head 6 (11.8) 4 (7.8) 11 (20.8) 8 (15.1)
Arm 6 (11.8) 5 (9.8) 6 (11.3) 4 (7.5)
Arm and trunk 21 (41.2) 21 (41.2) 16 (30.2) 17 (32.1)
Full body 2 (3.9) 0 (0.0) 1 (1.9) 0 (0.0)
Other 3 (5.9) 3 (5.9) 6 (11.3) 6 (11.3)
Offering reward None 40 (78.4) 7 (13.7) ＜.001 40 (75.5) 40 (75.5) .688
Yes (praised, hug) 11 (21.6) 44 (86.3) 13 (24.5) 13 (24.5)
Time spent on administration Within 1 minute 22 (43.1) 38 (74.5) ＜.001 28 (52.8) 30 (56.6) .402
Over 1 minute 29 (56.9) 13 (25.5) 25 (47.2) 23 (43.4)
Checking on remains of medication No 29 (56.9) 17 (33.3) ＜.004 19 (35.8) 18 (34.0) .500
Re-administration 22 (43.1) 34 (66.7) 34 (64.2) 35 (66.0)
Confidence in behavior of medication No 19 (37.3) 8 (15.7) ＜.001 18 (34.0) 17 (32.1) .500
Yes 32 (62.7) 43 (84.3) 35 (66.0) 36 (67.9)

† The variables of two categories were analyzed by McNemar test.

TOOLS
Similar articles