Educate parents about medications
One evening, a 15-month-old weighing 22 pounds was brought to the ED by ambulance after having a febrile seizure. "The child was post-ictal on arrival with a temperature of 103.6° rectally," recalls Theresa Cromling, RN, an advanced clinical staff nurse for the ED at Duke University Medical Center in Durham, NC. The mother told ED nurses that the baby had a fever earlier in the day and that she had given her "a little bit of Tylenol." "The pediatrician’s office had given her discharge instructions to continue giving Tylenol every four hours,’" says Cromling. The mother most likely administered too little of the medication, she explains.
The mother needed more specific instructions for the correct amount and frequency of the antipyretic to be given, she explains. Cromling gives the following example: "Give one teaspoon of children’s-strength Tylenol every four hours, and check the child’s temperature one hour after giving the medication."
"Had this mom been given this important information with her first encounter, the ED visit and ambulance ride may not have been necessary," according to Cromling. Although febrile seizures themselves are not life threatening because they are self-limiting, they are dangerous for another reason, notes Cromling. "There is the possibility of a compromised airway when the patient has a seizure," she warns. (See discharge instructions, below.)
Unfortunately, the above scenario is common in the ED, says Cromling. "When pressed for time, education can fall by the wayside," she says. ED nurses may have very brief interactions with parents and children, notes Cromling. "So you need to prioritize your time to include educational teaching for parents and caregivers about the administration of medicines to children," she says. (See ipecac follow-up care instructions, below.)
She suggests the following interventions:
• Give parents syringes to measure medications accurately. The spoons that parents use to administer medicines to their children vary widely, says Cromling. "This was shown during a study of medicine administration in our ED to check the accuracy of dosing amounts of antipyretics," she adds. She recommends giving parents a syringe for consistent measuring of medicines for children.
• Direct education to frequently used medications. Steroids, antibiotics, antipyretics, and analgesics are frequently prescribed in the ED, so you may want to focus your education on these medications, says Cromling.
• Tell parents to keep medications in their original bottles. Parents need to be warned about putting medications in bottles that the medicine does not originally come in, says Cromling. She points to the common example of pouring children’s-strength Tylenol into the infant-strength bottle because the bottle is smaller and fits easily into the diaper bag or purse. If the bottle of the infant’s strength is filled with the children’s-strength Tylenol and administered with the dropper, the child will be getting only one-third the dose of medicine they are supposed to be receiving, she explains. "Therefore, you will fail to treat the fever and predispose younger children to febrile seizures," Cromwell says.
• Instruct parents to follow instructions to the letter. Explain that if medicines are not given according to the prescription, the child may not be getting fever or pain relief, acute treatment for their asthma, or medication to fight the bacteria as intended, says Cromling. Warn parents not to share medicines with their other children or change doses or times that medicines are given without first consulting their doctor, says Cromling. "Medicine is prescribed for children according to their weight," she adds. "If the wrong dose is given, the child may be underdosed or overdosed, both having their own negative ramifications."