Caregiver Perceptions of Emergency Department Discharge Paperwork with a Visual Tool to Decrease Pediatric Medication Dosing Errors for Families with Limited English Proficiency

Limited English proficiency and limited health literacy are associated with medication dosing errors. Emergency department (ED) discharge paperwork can reduce the risk of pediatric medication dosing errors. Paperwork that provides weight and language specific instructions may help caregivers (i.e., parents/guardians) provide appropriate medication dosing. To understand caregiver perceptions of ED discharge paperwork aimed at decreasing pediatric medication dosing errors for acetaminophen and ibuprofen for families across multiple languages.

We designed an EMR-integrated discharge handout that provided weight-based dosing instructions for acetaminophen and/or ibuprofen in the caregiver’s preferred language. The handouts included the weight-specific dose and a visual tool depicting measuring the medication with a syringe. We conducted semi-structured qualitative interviews with caregivers of pediatric patients given this discharge handout after an ED visit within 48-72 hours post ED discharge. Interviews were conducted by phone with verbal consent obtained. Interviews were recorded and professionally transcribed; coding was completed using rapid thematic analysis among senior team members.

We conducted 30 interviews with caregivers of children seen at 7 ED sites using the discharge handout, in five languages: English (7), Spanish (8), Portuguese (7), Haitian Creole (7), and Mandarin (1). Caregivers described common barriers to understanding discharge dosing instructions including a chaotic ED environment, lengthy or non-native language paperwork, and lack of familiarity or access to a dosing syringe. To manage uncertainty, many caregivers relied on alternative sources such as family members or medication packaging. Participants reported that the handout helped by providing clear and precise information; additionally, they valued the visual syringe guide and that the handout served as a reminder and as a reference to share information with other caregivers.

In this qualitative study of caregivers across five languages, caregivers identified several barriers they face to understanding discharge dosing instructions in the ED and expressed value in our handout. Our findings suggest that this simple discharge handout may improve safe medication dosing for children discharged from the ED.