Children are a complex group of patients, not only because of their differences in drug handling; they are also at greater risk of medication errors. Children and young people use accident and emergency (A&E) services more frequently than adults, and recurrent emergency admissions are common, especially for children with chronic conditions such as asthma and epilepsy.
In 2015–2016, ten conditions accounted for 42% of all emergency admissions for children and young people in the UK, with the top three being viral infections, acute bronchitis and other upper respiratory infections, respectively.
The Care Quality Commission (CQC), the independent regulator of all health and social care services in England, surveyed all children who were discharged from hospitals from 137 NHS acute trusts during August 2014 to ask about their experiences of the care they received. Where a child was under eight years old, their parent or carer completed the survey. The overall response rate was 27% (n=7,253). The survey found that although parents generally reported a very good experience of hospital care, they highlighted the need for improvement in the availability of information provided on discharge. Around four in ten (39%) children were given new medicines to take home from hospital, and almost all parents and carers (92%) said they were given some information about these.
Less positively, more than a third of parents and carers (35%) did not feel fully involved in decisions about their child’s care and treatment. Involving parents, and where possible children, in decision making is key to medicines optimisation.
Communicating with and involving children in taking their medications will have a significant impact on their adherence.
Children take responsibility for their medications at different ages — young children often take responsibility for taking medications especially in chronic conditions such as asthma. A study in the United States by Boztepe et al. found that children were independently managing their medications, even though they had minimal knowledge about the medicines.
Children are often not present when their parents collect their medications from the pharmacy and, therefore, this prevents them from receiving counselling by community pharmacists. Interestingly, the CQC found that 13% of children aged 12–15 years said they had no involvement in decisions about their care while they were in hospital.
Therefore, although communicating with parents is essential, where appropriate, children should also be involved in discussions about their medications. This article explains the importance of communicating to parents and their children about their medications, and the role of the pharmacist, using practical examples.
What do we mean by communication?
Effective communication is responsive to the needs of the whole patient and family dynamic. Healthcare communication is different to the conversations we have with our family and friends in our everyday lives, because intimate and very private issues are often discussed.
It is suggested that good communication has the following three elements of doctor–parent–child communication:
• Informativeness: quantity and quality of health information provided by the doctor;
• Interpersonal sensitivity: affective behaviours that reflect the doctor’s attention to, and interest in, the parents’ and child’s feelings and concerns;
• Partnership building: the extent to which the doctor invites the parents (and child) to state their concerns, perspectives and suggestions during the consultation.
These elements should not be limited to just doctors; they are useful for all healthcare professionals to ensure useful communication. Parents’ most frequent criticisms of healthcare practice concern relationships with healthcare professionals; these relationships have a dramatic effect on parental satisfaction, recall of instructions and, not surprisingly, treatment adherence. For example, if parents feel openly able to discuss barriers to giving medications then healthcare professionals are better able to support the family.
Whose responsibility is medication taking?
Children often have to rely on their parents and/or carers to administer their medications. In England, Wales and Northern Ireland, parental responsibilities may be exercised until a young person reaches 18 years, whereas in Scotland this is until the child is aged 16 years. However, the law states that competent children can consent to diagnosis and treatment on their own behalf if they understand the implications of what is proposed.
The General Medical Council (GMC) advocates that children and young people should be involved in discussions about their care, and state that doctors should provide children and young people with information that is easy to understand and appropriate to their age and maturity about:
• Their conditions;
• The purpose of investigations and treatments proposed and what that involves, including pain, anaesthetics and stays in hospital;
• The chances of success and the risks of different treatment options, including not having treatment;
• Who will be mainly responsible for and involved in their care;
• Their right to change their minds or to ask for a second opinion.
The role of the pharmacist
The General Pharmaceutical Council, the independent regulator for pharmacy in Great Britain, has nine standards which all pharmacists must abide by. Standard three states that pharmacy professionals must communicate effectively. This includes adapting the communication to meet the needs of the patient being communicated with, and asking questions and listening carefully to the responses, to understand the patient’s needs and come to a shared decision about the care provided.
In 2013, the Royal Pharmaceutical Society, the professional leadership body for pharmacists in Great Britain, published good practice guidance for healthcare professionals. The guidance highlights the need for medicines optimisation, as it is well recognised that up to half of all patients do not take their medicines as recommended, which can lead to patient harm and medicines wastage. If 8% of parents feel they do not have enough information about their child’s new medications, is it fair to expect these parents to be able to give their children medications appropriately and safely?
* Culled from the Pharmaceutical Journal