1. Over half of families studied initiated a discussion on a medication topic during Family-Centered Rounds (FCR).
2. Eight percent of family-initiated medication dialogue during FCR lead to changes in the child’s treatment plan.
Evidence Rating Level: 2 (Good)
Study Rundown: The American Academy of Pediatrics recommends FCR to engage in shared decision making amongst the patient, patient’s family, and the healthcare team. This observational study examined FCR at a tertiary care hospital in the Midwestern United States to evaluate prevention and recovery of medication errors, specifically evaluating family-initiated dialogue surrounding medications. Daily FCR videos were recorded with participating patients and families, and standardized coders subsequently scoring the videos for family-initiated medication dialogue. In more than half of the video recorded encounters, families initiated medication dialogue. Most frequently, this dialogue was answered by the healthcare team further providing information to the family. However, in 8 percent of cases, such dialogue raised by the family lead to changes in the child’s treatment regimen. Though limited by its single-center and self-selected study population, this study suggests family-initiated medication dialogues to be a common and beneficial aspect of systems-based practice and FCR.
In-Depth: Of the 150 families recorded through 347 FCR video episodes at a single tertiary center acute hospitalist service, 55% of families raised a medication-related dialogue. This dialogue was broken down into 3 categories: 1) inpatient or outpatient administration of medication, 2) medication therapeutic class, and 3) specific topic raised regarding medication. Data was also collected on how the healthcare team responded to this family-initiated medication dialogue (change to the medication plan, provision of information, not addressing dialogue), how this dialogue changed the child’s treatment regimen, and whether the medication change was appropriate. Eight percent of family-initiated medication dialogues lead to a change in the child’s treatment regimen. The remainder included provision of information by the healthcare team (74%), acknowledging the dialogue (13%), actively deferring the conversation (5%), and not addressing the parental dialogue (1%). All medication changes made were deemed appropriate. Families most commonly asked about medication scheduling (24%), followed by adverse drug reactions (11%).
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