Prescribed antimicrobial therapy: what parents/carers are told and what they would like to know
Aims The aims of this study were to:
Assess the drug related information provided to parents/carers of children prescribed an antibiotic during their in-patient stay and as part of the discharge process from Birmingham Children's Hospital.
Determine the compliance of a tertiary paediatric centre with the ‘Patients, Carers and the Public’ domain of the Antimicrobial Self Assessment Toolkit (ASAT).1
Methods A qualitative investigation of 30 parents/carers of in-patients was undertaken during January and February 2012. Face-to-face interviews were conducted using a semi-structured questionnaire on the ward with telephone follow-up after discharge. The questions were based upon recommendations of the ASAT. The themes included in the questionnaire were knowledge that an antibiotic had been prescribed, indication for use, duration of therapy, knowledge of adverse effects, where to seek advice and whether any information provided met parent/carer expectations. Participant responses were transcribed verbatim and analysed using content analysis.
Results Thirty patients consented for a ward based interview with twenty (66.7%) consenting to telephone follow-up.
Twenty-five (83.3%) parents/carers had been advised that their child had been prescribed an antibiotic as an in-patient. Six (24%) of these had been informed about the adverse effects associated with treatment.
During the discharge process 19/20 (95%) parents/carers were informed that their child had been prescribed an antibiotic. Five (25%) had been informed about adverse effects. Eighteen parents/carers (90%) were advised of the course length. Eleven (55%) patients were informed where to seek further advice on their antimicrobial therapy.
Parents/carers suggested a number of areas where they required further information. These included the rationale for antibiotic therapy (n=1), changes made to therapy during treatment (n=1), the long term safety of therapy (n=1), the risk of tolerance/reduced effectiveness (n=2) and assurances of eradication of infection/risk of recurrence (n=5). One parent suggested that a patient information leaflet be provided whilst an in-patient.
Conclusions This study demonstrates that a national antimicrobial stewardship quality indicator may be used to assess the provision of information to parents/carers in the paediatric setting. Further work is needed to improve the provision of information on adverse effects and where advice may be sought should these occur following discharge from hospital.
Parents/carers required more information about treatment decisions, expressed concerns about the safety of therapy and required assurances of treatment success. Addressing these concerns would further reinforce the importance of prudent antibiotic use among parents/carers and patients.
Patient/carer expectations may differ depending on the reason for admission and social/educational background. These were not formally evaluated in this study.
The results of this study will inform the development of interventions to improve information provision both at ward level and discharge. The use of written information to supplement verbal counselling is currently being considered.