503 - Leveraging the EHR to Promote Pharmacy Adoption of Dosing Best Practices and Reduce Parent Errors in Administering Pediatric Liquid Medications: A Health Literacy-Informed Approach

Publication Number: 4494.503

H. Shonna Yin, NYU Grossman School of Medicine, New York, NY, United States; Alexander F. Glick, New York University Grossman School of Medicine, New York, NY, United States; Jennifer Melgar, New York University Grossman School of Medicine, BROOKLYN, NY, United States; Dylan Muro-Wong, State University of New York Downstate Medical Center College of Medicine, Brooklyn, NY, United States; Jessica Velazquez, New York University Grossman School of Medicine, New York, NY, United States; Alan L. Mendelsohn, New York University Grossman School of Medicine, New York, NY, United States

Background: To reduce parent liquid medication dosing errors, prior research and an AAP policy statement support the use of health literacy-informed dosing best practices (i.e. mL-only dosing instructions and provision of an optimal dosing tool [smallest tool to fit the dose without requiring measurement of multiple instrument-fulls]). Pharmacy adoption of these best practices is variable, and there has been limited study of strategies to support their adoption.

Objective: To examine the efficacy of an EHR-based intervention in improving pharmacy adoption of dosing best practices and reducing parent dosing errors.

Design/Methods: Pre-/post-implementation study within two urban hospital systems (1 public, 1 private); outcomes assessed before and after implementation of an EHR intervention in which a pharmacist e-Rx note was included (“Please give dosing instructions in ‘mL’ only (no tsp). Give the right sized dosing tool: For doses 1 mL or less, give 1 mL syringe. Doses >1 to 5 mL, give 5 mL syringe. Doses >5 to 10 mL, give 10 mL syringe.”) Inclusion criteria: parent of child < 8y, prescribed daily dose short course ( < 14d) or chronic medication in ED, general outpatient or subspecialty clinic, dose < 10 mL, English/Spanish-speaking. Outcome variables: mL-only dosing instructions on Rx label, pharmacy provision of optimal dosing tool, parent dosing error=>20% deviation from prescribed dose [in-person demonstration]. Multiple logistic regression analyses performed adjusting for potential confounders (hospital system; parent age, race/ethnicity, country of birth, health literacy [Newest Vital Sign]; child age, insurance, chronic disease status).

Results: 472 caregivers (87.5% Hispanic, 88.1% non-US born, 86.4% Medicaid/no insurance, 45.3% with low health literacy). There was no difference seen in use of mL-only pre- v. post-implementation (72.6% v. 67.8%, p=0.3). More pharmacies provided an optimal tool post-implementation (pre v. post: 34.8% v. 46.4%, p=0.01; aOR=1.6 [95%CI: 1.1-2.5]). There were also fewer dosing errors post-implementation (pre v. post: 27.5% v. 17.5%, p=0.02; aOR=0.5 [0.3-0.8]).

Conclusion(s): Implementation of an EHR-based intervention was associated with a higher odds of pharmacy provision of an optimal dosing tool and a lower odds of parent dosing errors. Additional study is needed to examine how to further increase pharmacy adoption of dosing best practices.