Administration of anticonvulsive rescue medication in children-discrepancies between parents' self-reports and limited practical performance

Eur J Pediatr. 2016 Sep;175(9):1139-1146. doi: 10.1007/s00431-016-2750-6. Epub 2016 Jul 1.

Abstract

Quality of parents' performance in administering anticonvulsive rescue medication to their children suffering from seizures is unknown. After obtaining ethical approval, we used a questionnaire to ask parents of children with seizures, who had been prescribed rescue medications, about their experience in administering those. To assess the frequency of actually committed drug-handling errors, we let them administer rescue medications to dummy dolls. An expert panel rated the clinical risk of handling errors from "1" (lowest) to "6" (highest). Eighty-one parents completed the study. In the questionnaire, 85 % (100 %) of parents that already conducted rectal (buccal) administration reported that they had never experienced problems. The number of rectal administrations with at least one handling error (97 %, 58/60) was higher than in buccal administration (58 %; 14/24; p < 0.001). According to logistic regressions, previous use of rescue medication was not a predictor of the number of committed errors per process (n. s.). All errors were rated with a high clinical risk (class 4-6).

Conclusion: By observing parents' administration of rescue medication to dummy dolls, we found a high frequency of clinically relevant drug-handling errors. Most parents, however, self-reported to have never experienced problems while administering rescue medications to their children.

What is known: • For seizures with duration of more than 5 min, the administration of anticonvulsive rescue medication is recommended. • Outside the hospital, the administration of rescue medication to children is performed most frequently by their parents. What is New: • Most of the parents reported that they had never experienced problems in handling anticonvulsive rescue medication. • But in the observed drug-handling performances, identified errors committed by parents were alarmingly frequent and pose a high clinical risk according to an expert panel.

Keywords: Anticonvulsants; Handling errors; Rescue medication.

Publication types

  • Observational Study

MeSH terms

  • Administration, Buccal
  • Administration, Rectal
  • Adolescent
  • Adult
  • Anticonvulsants / administration & dosage*
  • Child
  • Diazepam / administration & dosage
  • Emergency Treatment
  • Female
  • Humans
  • Logistic Models
  • Male
  • Medication Errors / statistics & numerical data*
  • Midazolam / administration & dosage
  • Middle Aged
  • Parents*
  • Risk
  • Salvage Therapy / statistics & numerical data
  • Seizures / drug therapy*
  • Self Report
  • Surveys and Questionnaires
  • Young Adult

Substances

  • Anticonvulsants
  • Diazepam
  • Midazolam