Parents often make follow-up care mistakes after kids leave hospital

When sick kids leave the hospital, parents often do not understand what follow-up care is needed or how to give children medicine at home, a research review suggests. 

Getting instructions right is essential to avoid mistakes that can prolong children’s illnesses or make them sicker, sometimes so much worse that they need to return to the hospital for additional care, researchers note in paediatrics. 

In the review of 64 studies, medication errors were the most common problem researchers found. For example, up to 38 per cent of parents and caregivers did not know the right medicine dose and up to 42 per cent of them did not understand how often children needed to take prescribed drugs. 

Dosing errors with prescriptions — when parents gave kids at least 20 per cent more or less medication than they were supposed to — occurred 42 per cent to 48 per cent of the time. The majority of these errors happened with measuring liquid medications that are commonly used for children. 

“Underdosing medications may lead to worsening of a child’s illness, while overdosing puts children at risk for dangerous side effects,” said lead study author Dr Alexander Glick, of New York University School of Medicine and Bellevue Hospital Centre in New York. 

Parents also frequently misunderstood what follow-up appointments kids needed and what signs of worsening illness would require children to return to the hospital, the study found. 

Up to 62 per cent of families missed recommended follow-up appointments after kids were discharged from an inpatient hospital stay, as did up to 81 per cent of families of children treated in emergency rooms. 

Parents were more likely to miss these appointments or fail to schedule them when they had more than one child, lacked private health insurance, spoke little or no English or had difficulty missing work or taking kids out of school for doctor visits, researchers report in Paediatrics. 

“When children miss follow-up appointments, they lose the opportunity for additional monitoring and physicians also cannot ensure that parents are following instructions correctly,” Glick said by e-mail. “Misunderstanding discharge instructions has the potential to lead to unnecessary and unanticipated readmissions and visits to the emergency department.” 

Kids were more likely to go to needed follow-up appointments when these visits were scheduled before they left the hospital, the study found. 

Medication mistakes were less common when clinicians spent time in the hospital showing parents the correct way to fill medication cups or syringes to give children the right amount of liquid medicine. 

Researchers got this snapshot of how well parents understand discharge instructions for their children by analysing data from studies published between 1985 and 2016. Most were done in the US, but some also examined what happens in Canada, Chile, India, Israel, Rwanda, Saudi Arabia, Switzerland, Taiwan and Uganda. 

One limitation of the current review is that the studies analysed tended to rely heavily on research done during the day for convenience, which excludes kids sent home from hospitals on evenings and weekends, the authors note. This may have underestimated how often parents misunderstand instructions because they are more likely to get help understanding needed follow-up care on weekdays. 

Even so, the analysis offers fresh evidence of how often parents fail to follow doctors’ orders for medications and follow-up appointments their kids need, said Dr Denise Klinkner, medical director of the paediatric trauma centre at Mayo Clinic in Rochester, Minnesota. 

“This study highlights the overwhelming rate of non-compliance with medications and follow-up,” Klinkner, who was not involved in the study, said by e-mail. “Especially for the more complex children, failure to comply may lead to lifelong disability and chronic disease.” 

To avoid mistakes, parents should speak up when they do not understand instructions or when factors like a lack of insurance or transportation might prevent them from getting children needed care, Klinkner added. Clinicians should also keep instructions simple and ask families questions to make sure they understood what they were told. 

“A team approach is key,” Klinkner said.