1 LITERATURE REVIEW

1.1 Medication Administration

Medication is the most common medical therapy used to promote quality of life in
patients through treating the disease and minimizing the adverse drug events (ADEs) that
may accompany medication administration(Kozer, Berkovitch, &Koren,2006; Miller,
Robinson, Lubomski, Rinke, &Pronovost, 2007; Walsh et al., 2011). The quality of the
medication is always a crucial factor for the health of all human being in the world. Basically
medication administration is defined as preparing, giving and evaluating the effectiveness of
prescription and non-prescription drug (Santell & Hicks, 2005). Therefore medication
administration goes beyond a general prescription for a specific disease. It includes both
prescription and non-prescription drugs.

1.2 Pediatric medication administration

When dealing with children it is really important to provide an error and defects free
service to them. Otherwise it will affect for children in different ways. Children have greater
risk than adults in medication errors. Medication errors will affect for children in different
ways. It will affect for the development and many other factors effect on the growth of the
children. Most of these errors are preventable. Doctors and other parties have to careful when
prescribing, dispensing and administering medical solution for children than adults (Shrek, et
al., 2006)

1.3 Medication Errors

People have to use medicine in a careful way. These medicine products also include
harmful facts. Therefore people have to be very careful when they use medicine. Regular use
of certain medicine products will provide negative impact for people. Errors of medical
products are really low. If there is an error in medicine which people buy health care of the
people will be in a danger? The important thing is most of these errors are preventable.
Understanding the errors and these defects of medication will help to find the safety and
quality developments in their products. The safety and quality must be assessed in
equipments, practices of individuals and systems of managing medicines (Prof Libby
Roughead, 2013)
 Pediatricians are rendering care in an environment that is increasingly complex, which
results in multiple opportunities to cause unintended harm
(American_Acedemy_of_Pediatrics, 2018).

Previous studies have identified the death rates and diseases are high in pediatric
patients due to the various medication errors. Another major finding was the healthcare cost
is high in these medication errors (Bailey et al., 2009; Gonzales, 2010; Lindell-Osuagwu et
al., 2013).
There are many children identified with chronic conditions. This has increased
dramatically in past 20 years. The main reason for this is many students try to handle this
situation individually with limited knowledge about medications, improper methods and
errors in dosing has increased this problem (Abraham, Alexander & Carpenter 2017)
Participants of this research has told that their children were managing by them even
though they don’t have a proper knowledge about medicines and other important facts
(Abraham, Alexander & Carpenter 2017)

1.4 Need for the study

Medicines are most popular curative that use for health problems of people and it has
used for developments in the health sector in various ways. Furthermore medicines are
including harmful chemistry which leads to adverse events of health care in regular using.
Even though rates are low in errors of medication errors, these errors are making some
negative outcomes and healthcare costs for people. The expansion of medication errors is
paying a huge attention in the society. The main reason for that is most of these errors is
preventable (Roghhead, Semple, & Rosenfield, 2013)

Pediatric patient-safety efforts need to be researched further to determine the best

strategies for reducing these preventable harms in children (Kozer, Berkovitch, & Koran,
2006)
A questionnaire was provided for parents from children’s hospital. The main aim of
this questionnaire is to get an idea about the experiences and problems with administering
medication to their children at home. This questionnaire was delivered to four hundred
parents.

The most common medicines used by parents without a proper prescription was
Antipyretics (59%) and antibiotics (25%). Most of the parents responded that they give liquid
medicines with a spoon. Major finding from this questionnaire was 54% of children refused
to take any food or liquid mixed with medicines. The curative of the disease is delayed due to
the children who refuse the take tablets and liquids. 20.7% was the percentage of children
who refuse to take tablets and 29.1% was the percentage of children who refuse to take liquid
medicine. Due to this factor recovery was delayed. Due to these circumstances special
equipment was developed to oral medication for children in houses.

The outcome of this project showed that most of the parents didn’t use the correct
equipment for medications, most of the parents used non-prescription medicines and they
have mixed the medicine with foods as wellInvalid source specified..

1.5 Article 1
This study identifies administration of medication to their children at home and the
understanding of these parents of adverse drug events (ADEs). Data was collected from 179
parents of pediatric patients. This data was gathered from two hospitals and three day care
centers in Korea. Results from this research were parents give antipyretics (94.4%),
decongestants (89.4%), and antibiotics (77.7%) to their children at home. Parents get the
information about medication from instruction sheets. Most of the parents use dosing cups
(43.6%) and droppers (32.9%) to give liquid medicine to children.15.1% of the parents were
unsure about the proper dosage to give their children and 11.1% were unsure about the
method to provide the medicine. Variance studies have showed the parents education and
monthly income is having a consequential impact on understanding of ADEs. These findings
proposed that parents must have a proper education to avoid the errors of using medication.
There must be proper ways to reduce these errors among lower income families and less
educated families. There must be enough home visits to provide understanding about these
medication errors and provide this information to parents. They must make proper strategies
to give these training and information to reduce these medication errors and ADEs (You,
Nam, & Son, 2015).

During past years, painkilling medicine at home has become a compulsory option for
ill children. This research shows the experience of caring for a dying child at home from a
parent’s perspective. The researcher has used the qualitative research approach to conduct the
research and analyze the data. Researcher has used non standardized focused interviews in 10
families around the area. According to this research most parents like to take a risk and
provide the nursing care to their own children. This includes the medication and
administration as well. Most of the parents and children think it is the best place to provide
terminal care for them (Vickers & Carlise, 2000) In Sri Lankan context most of the rural area
families do the same. They are willing to take care of their children when they affected with a
disease. Most of the uneducated and poor families do the same in Sri Lanka.

1.6 Article 2
Children of every continent are at a risk of adverse drug reactions. We define an ADR
as a “harmful or unpleasant reaction, resulting from an intervention related to the use of a
medicinal product, which predicts hazard from future administration and warrants
prevention or specific treatment, or alteration of the dose regimen, or withdrawal of the
product (Arnott, et al., 2012)

Parents have small experience of reactions of adverse drug. They basically suspected
their children with their body language.These information gathered when they communicate
with families about their medicines.

Many parents have dissatisfied feeling about the clinicians which communicated
about adverse drug reactions. They don’t have a clear implication of these medicines and
about their children future. Parents felt clinicians have provided so much information about
these adverse drug reactions and it has complicated this issue in their children. When their
parents are cancer patients their profile was totally different. Clinicians explained the major
risk with these adverse drug reactions and what are those impacts which affect for their
children in long term way.Most of the parents linked the symptoms of the disease with
medicines which will help to evaluate the adverse drug reaction situation.

There was a poor perspective of parents about the communication method of these
clinicians about adverse drug reactions. They expected more from them to reduce these
adverse drug reactions. The profiles of children with cancer must indicate sufficient
information about these adverse drug reactions. The starting point for this improved
communication situation must be the link of symptoms with medicines.

1.7 Article 3
Information about child cancer is really important factor in pediatric oncology. This
information about child cancer is really important to develop a meaningful understanding
about their child and about the situation. This information also help to reduce the unnecessary
fear of parents, increase the control of the parents, help to create a normality in parents minds
and it will help to create an advocate for their child as well.

In pediatric oncology, information about the child’s cancer is a vital part of the care
given to parents. Information can help parents create knowledge and build a meaningful and
intelligible understanding of the situation. Information also contributes to reducing chaos,
creating normality, increasing the parents’ feeling of control, and helping parents to advocate
for their child (Björk, Wiebe, & Hallström, 2005; Earle, Clarke, Eiser, & Sheppard, 2007;
Holm, Patterson, & Gurney, 2003; Wong & Chan, 2006; Woodgate&Degner, 2002).

When information lacks consistent definition, the gaps between other concepts such
as social support and patient education will be missed Therefore it’s really important to hae a
clear definition with information (Leino-Kilpi, Mäenpää, &Katajisto, 1999; Piredda, 2004;
Stoltz, Andersson, & Willman, 2007).7 – 244

There are difficulties in using the information. Parents can be helpless when there is
limited sources of information available. When there is a limited information it is described
as equal to learning a new language which totally new for a person. Medical terminology
subject is really difficult to understand. Objective of this subject is to identify the crisis
reaction of parents. There are occasions where parents know about the situation of their
children diagnosis or prognosis can be marked by stress .Björk et al., 2005; Clarke &
Fletcher, 2003; McGrath et al., 2007; Ringnér et al., 2011

The researchers of this research have used qualitative approach to analyze the data of
the research. They have used focus groups and individual interviews of 14 parents of cancer
affected children. The researchers have constructed two major themes. They are (a) feeling
acceptable person and they must feel safe and secure in the society, (b) feeling unaccepted in
the society and forced to negative information. To reduce the treatment of the children
parents need some extra effort and attention with the patients (Ringnér, Jansson & Graneheim
2011).

1.8 Article 4
Pharmacists provide counseling service for children and parents aboiut medication.
But children are not interacting with pharmacists. Most of the parents and children are using
technology to get the education about medication. More in this research we can identify how
pharmacists use technology to increase the pediatric counseling and develop the knowledge
of children about the safety of their medicines (Abraham, Alexander, & Carpenter,
2017)Therefore technology is playing a big role in providing accurate knowledge to children
and their parents about pediatric medication.
2 Questionnaire
4/29/2018 Parents’ Knowledge of Medication Administration and Side
Effects When Treating Children at Home
https://docs.google.com/forms/d/1QBwpsWwQn4OlIvawkGir_uPTmB
2xG68P347wyGhatFE/edit 1/5
Parents’ Knowledge of Medication
Administration and
Side Effects When Treating Children at
Home
I am a student at EMSc in Healthcare Administration, Asia e University
– Malaysia. This questionnaire
is prepared and presented to you as a mandatory requirement of my
Bachelor of Nursing Science
(Hons) programme.
The aim of this research is to study on parents’ knowledge of
medication administration and side effects
when treating children at home in Balummahara Suburb, Sri Lanka. I
kindly request your support for
succession of my research.
I certify you that this information is only used for my education purpose
and the information collected
will not be shared with another third party.
* Required
1. Types of medication administered to a child? *
Check all that apply.
Antipyretics
Decongestants
Antibiotics
Expectorants
Cough medication
Antidiarrhetic
Other:
2. Which methods do you use to administer medication of your child? *
Check all that apply.
Dosing cups
Dosing bottle
Oral syringe
Cylindrical spoon
Household spoon
Other:
3. What are the main source of information which you used for medication administration of
your child? *
Check all that apply.
Instruction sheets
Guildlines from the Doctors
Instructions from the Pharmacists
Instructions from friends/ relatives /neighbors
Other:
4/29/2018 Parents’ Knowledge of Medication Administration and Side Effects When Treating Children at Home
https://docs.google.com/forms/d/1QBwpsWwQn4OlIvawkGir_uPTmB2xG68P347wyGhatFE/edit 2/5
4. Have you purchased overthecounter
(OTC) medications from a pharmacy? *
Overthecounter
(OTC) drugs are medicines sold directly to a consumer without a prescription from
a healthcare professional, as opposed to prescription drugs, which may be sold only to consumers
possessing a valid prescription.
Mark only one oval.
Yes
No Skip to question 9.
Parents' Attitudes towards Medication Administration
5. What are the medication which you purchased OTC from a pharmacy? *
Check all that apply.
Antipyretics
Cold medication
Antidiarrhetic
Cough medication
Non of the above; can't remeber
Other:
6. Have you ever reused the medication for a child? *
Mark only one oval.
Yes
No
7. Have you given same medication for siblings? *
Mark only one oval.
Yes
No
8. Level of your awareness on medication administration of children? *
Mark only one oval.
Very high (I know everything) Skip to question 12.
High (I have a greater understanding on medication administration of children) Skip to
question 12.
Neutral (I know only basic information on medication administration of children) Skip to
question 12.
Low (I have only general idea on medication administration of children) Skip to question
12.
Very low (I don’t know anything or very little information) Skip to question 12.
Parents' Attitudes towards Medication Administration
4/29/2018 Parents’ Knowledge of Medication Administration and Side Effects When Treating Children at Home
https://docs.google.com/forms/d/1QBwpsWwQn4OlIvawkGir_uPTmB2xG68P347wyGhatFE/edit 3/5
9. Have you ever reused the medication for a child? *
Mark only one oval.
Yes
No
10. Have you given same medication for siblings? *
Mark only one oval.
Yes
No
11. Level of your awareness on medication administration of children? *
Mark only one oval.
Very high (I know everything)

Please find the PDF for the questionnaire

High (I have a greater understanding on medication administration of children)
Neutral (I know only basic information on medication administration of children)
Low (I have only general idea on medication administration of children)
Very low (I don’t know anything or very little information)
Parents' Behavior on Medication Administration
Indicate your level of agreement with the following statements
12. *
Mark only one oval per row.
Highly
Satisfied Satisfied Neutral Dissatisfied Highly
dissatisfied
Your confidnce level of dosage
of medication
Your confidence level of
medication method
Awareness of medication
administration of children
Are you satisfied with the time
that you allocated for your
children
13. Do you prefer for prescribe medication rather than nonprescribe
medication? *
Mark only one oval.
Yes
No
14. How would you rate your awareness on the side effects of medication administration of
children?
Mark only one oval.
12345
Very Poor Excellent
4/29/2018 Parents’ Knowledge of Medication Administration and Side Effects When Treating Children at Home
https://docs.google.com/forms/d/1QBwpsWwQn4OlIvawkGir_uPTmB2xG68P347wyGhatFE/edit 4/5
15. Do you required further awareness program for medication administration for children? *
Mark only one oval.
Yes
No
16. Please tell us your overall idea on Medication Administration and side effects when treating
children at home
Demographic Information
Finally, please tell us a little about yourself.
17. What is your gender? *
Mark only one oval.
Female
Male
18. Your age group *
Mark only one oval.
Below 20
21 30
31 40
41 50
51 60
Above 61
19. What is the highest level of education you have completed? *
Mark only one oval.
Graduate / undergraduate
Professional Qualifications
Advanced Level
Ordinary Level
Primary Education
Other:
4/29/2018 Parents’ Knowledge of Medication Administration and Side Effects When Treating Children at Home
https://docs.google.com/forms/d/1QBwpsWwQn4OlIvawkGir_uPTmB2xG68P347wyGhatFE/edit 5/5
Powered by
20. Level of monthly family income *
Mark only one oval.
Less than LKR 20,000
LKR 20,000 40,000
LKR 40,000 60,000
LKR 60,000 80,000
LKR 80,000 100,000
Above 100,000
21. How many children (dependents) for your family? *
Mark only one oval.
Only one child
Two children
Three children
Other:
22. Are you employed? *
Mark only one oval.
Yes
No
23. Do you have enough time for medication administration of your child?
Mark only one oval.
Yes
No
Maybe
Please click on the below image for the PDF file of the questionnaire;
References
Abraham, O., Alexander, D. S., & Carpenter, D. (2017). Pediatric medication use experiences
and patient counseling in community pharmacies. Journal of the American
Pharmacists Association, 57, 39.

American_Acedemy_of_Pediatrics. (2018). Policy Statement—Principles of Pediatric

Patient.

Arnott, J., Hesselgreaves, H., Nunn, A., Peak, M., Pirmohame, M., Smyth, R., & Turner, M.
(2012). Enhancing Communication about Paediatric Medicines: Lessons from a
Qualitative Study of Parents' Experiences of Their Child's Suspected Adverse Drug
Reaction. Journal Pone.

CRPNBC, C. o. (2013). Medication Administration - PRACTICE STANDARD. Columbia.

Retrieved from https://www.crpnbc.ca/wp-content/uploads/2011/02/2013-04-30-
Medication-Administration-Formatted.pdf

Kozer, E., Berkovitch, M., & Koran, G. (2006). Medication Errors in Children. Pediator Clin
North Ame, 53(6), 1155-1168.

Mi-Ae You, S.-M. N.-J. (2015). Parental Experiences of Medication Administration to

Children at Home and Understanding of Adverse Drug Events. Cheonan, Republic of
Korea: The Journal of Nursing Research.

Prof Libby Roughead, D. S. (2013). Medication Safety in Australia. Darlinghurst: Australian

Commission on Safety and Quality in Health Care.

Roghhead, L., Semple, S., & Rosenfield, E. (2013). Medication Safety in Australia. 06.

Santell, J. P., & Hicks, R. (2005). Medication Errors Involve in Pediatric patients. Journal on
quality and patient safety, 31, June.

Shrek, P. J., Horbor, J. D., Mason, W., Bisariya, H., Thuram, C. V., Suresh, G., . . . Classen,
D. (2006). Adverse Events in the Neonatal Intensive Care Unit: Development,
Testing, and Findings of an NICU-Focused Trigger Tool to Identify Harm in North
American NICUs. American Academy of Pediatrics, 118(4), 118-134.

Vickers, J. L., & Carlise, C. (2000). Choices and Control: Parental Experiences in Pediatric
Terminal Home Care. Journal of Pediatric Oncology Nursing, 12(22), 1.
You, M. A., Nam, S. M., & Son, Y. J. (2015). Home and Understanding of Adverse Drug
Events. The journal of nursing research, 23(3).