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ACCIDENTAL INGESTION OF MEDICATION IN CHILDRENPresented By:Mallory Olson, Debby Boyle, Diedre Bringold, Stacie Brown and Koren May

Accidental Ingestion of Medication in Children as presented by Mallory Olson, Debby Boyle, Diedre Bringold, Stacie Brown and Koren May1Summary of Analysis

Summary of Analysis2Problem StatementUnintentional ingestion of medication by children under the age of five as evidenced by increasing incidence in statistical data of children who live in Kent County, Michigan.

Our group has developed a plan, including goals and interventions to address the community health diagnosis: unintentional ingestion of medication by children under the age of five as evidenced by increasing incidence in statistical data of children who live in Kent County, Michigan.3Risk FactorsMultigenerational HousingImproper Storage of MedicationsLook-a-like MedicationsLanguage BarriersPolypharmacy

Kent County had a population of 602,622 people in 2010, 7.3% being children under the age of five. This is higher than the national average. The incidence of unintentional ingestions of medication is increasing in Michigan and the population of children under the age of five is at an increased risk. In Kent County, risk factors for unintentional ingestion of medication in children under the age of five include multigenerational housing, improper storage of medications, look-a-like medications, language barriers, and polypharmacy.4COMMUNITY CHANGE PROJECT

Community Change Project5Change CommitteePublic Health Direct Contact NursePublic Health Nurse ManagerPharmacist From the CommunityCommunity MemberThis committee will meet twice monthly for 2 hours.

The community change committee will consist of two public health nurses; a direct contact nurse, and a nurse manager. Also included in this committee will be a pharmacist from the community, as well as a lay person from within the community. This committee will meet twice monthly for two hours.6PlanDetermine at risk homesDevelopment assessment criteria/questionsSolicit donations of lock boxes for medicationsProvide education to parents and grandparents Provide educational and distribute educational materials (i.e. brochures).

The nurse manager/leader will be an employee of the Public Health Department and will take an administrative role on the committee for change. His/her role will include researching past/current data, analyzing outcomes, developing policy, and managing the direct care nurse. The direct care nurse will also be an employee of the Public Health Department. He/she will take part in deciding how to go about collecting the data, how many homes to assess, which clients to interview, and when data should be collected as well as introducing and implementing the plan for change. The direct contact nurse will be identifying at risk families from those that are seen in the health department. The pharmacist will participate in discussions and contribute knowledge of medication use and storage to the group. The community member will give feedback from the standpoint of a lay person and be able to give insight as to how the community may accept this project.7At Risk HomesDefinition - A home where a child 5 years or under lives and has one or more of the following risk factors; multigenerational housing, improper storage of medications, language barriers, and polypharmacy.

During the months of January-March 2012, the direct contact nurse will identify at risk homes from the clients that are seen at the health department. When the nurse identifies an at risk home he/she will educate the client on the community change project and get consent for home assessment and interview to be conducted during the months of May-July 2012.8GoalsRaise awareness of the problemIncrease in availability of educationDecrease rate of incidence of accidental ingestion over a two year periodSave lives

The goals of the committee for change will be to raise awareness of the problem by increasing availability of education and educating providers and pharmacists. This will be accomplished by working with these disciplines to educate their clients by providing educational materials in various languages, decreasing rate of incidence of accidental ingestion over the next two years thus saving lives.9Interventions

Interventions10

The PRECEDE-PROCEED model for health promotion provides a structure which helps to evaluate communities, determine needs, and plan educational programs to improve health. PRECEDE stands for Predisposing, Reinforcing, and Enabling Constructs in Ecosystem Diagnosis and Evaluation. PROCEED is the second component of the model which stands for Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development (Pender, Murdaugh, and Parsons, 2011).11InterventionsMake safe storage suggestionsGiving clients lock boxes/cabinet locksPresent educational materials in clients first language through use of medical interpreter or translator for written materials

Provide poison control number stickers for home telephonesEducate the community on rates and prevention through the distribution of brochures to schools, pharmacies, and physician offices

After the direct contact nurse at the health department has gotten permission for in-home assessments, he/she would then go to these homes. Once there the direct contact nurse will make suggestions for safe storage of medications, give clients lock boxes or cabinets locks, present educational materials in clients first language through use of medical interpreter or translator for written materials, provide poison control number stickers for home phones, and educate the community on rates and prevention through the distribution of brochures to schools, pharmacies, and physician offices.12Physicians have an important opportunity to assist in preventing pediatric pharmaceutical exposures by instructing parents and grandparents on how to better limit childrens access to medications as an essential component to enhance child safety (Carraccio & McFee, 2006, p. 405).

Physicians have an important opportunity to assist in preventing pediatric pharmaceutical exposures by instructing parents and grandparents on how to better limit childrens access to medications as an essential component to enhance child safety (Carraccio & McFee, 2006, p. 405).13Educational MaterialsBrochuresFocus is on preventionRemove potential poisons/medications from the sight and reach of childrenBe sure to properly close child-resistant containersKeep hazardous substances in their original packagingProperly dispose of unused medicationsDo not describe medicine as candy

The brochure will focus on prevention. Highlighting areas such as removal of potential poisons/medications from the sight and reach of children, being sure to properly close child-resistant containers, keeping hazardous substances in their original packaging, proper disposal of unused medications, as well as avoiding taking medications in front of children or referring to medications as candy. (Carraccio & McFee, 2006, p. 408).14

LOOK ALIKE MEDICATIONS:

Make a display of available pills. Find candiesthat look like pills and hot glue on posterboard & place in a clear plastic box frame. Letthe client guess which are pills and which arecandy. Relate this to a childs perspective.

White Tylenol caplets and Good N Plenty

Red round Sudafed and Red Hot Candies

Colored gelcaps (any kind) and jellybeans

Pastel round flat antacids and SweeTarts

Round coated Advil and tropical M&Ms

Brown round pyridium and M&Ms

The importance of not referring to medications as candy in front of children can be seen by this slide. On the left are medications and on the right candy. Examples are white Tylenol caplets that look like Good N Plenty. Red round Sudafed can easily be mistaken for Red Hot Candies. Colored gelcaps (any kind) and jelly beans, pastel round flat antacids and SweeTarts. A round, coated Advil and a tropical M&Ms and a brown, round Pyridium can be mistaken for a brown M&M.15

Comparison of the impact of access and storage practices prior to pediatric pharmaceutical exposure incidents. Preincident locations are classified as easy access if the medications were placed in direct proximity to the child or at 3 feet above the ground or lower prior to the incident. Secure locations are anywhere higher than 3 feet above the ground (Carraccio & McFee, 2006, p. 408).

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This graph is a summary of non-child resistant containers in use during pharmaceutical exposure incidents (Carraccio & McFee, 2006, p. 408). As one might expect, as the container gets harder to open, the risk of exposure is decreased.17

This third and final graph shows a comparison of secure and easy access medication locations prior to pharmaceutical exposure incidents. (Carraccio & McFee, 2006, p. 408). Being able to see and reach the medications significantly increases the risk of unintentional ingestion. Having the medications in a secure location, out of sight, and/or out of reach is an effective way to reduce this risk.

18Evaluation

Evaluation19EvaluationRe-assess the same homes January-March 2013 using random appointmentsCheck accidental ingestion rates after 2 yearsCommittee will meet to analyze incidence rates and assess whether there was improvement or notCommittee will address problems or improve-ments to plan/interventions

Six months after implementation of the plan, evaluation will begin. In the months of January-March 2013, the same homes will be reassessed. Compliance rates will be determined and compared to the rates of unintentional ingestion of medication by children two years after the implementation of interventions. The committee for change will meet after these rates have been determined to analyze and compare the new data to the old. This committee will determine whether there was improvement or not and what if any barriers were identified. If improvement is seen, policies can be written to address changes to current practice. The health department may be required to educate at risk families during visits with the nurse. Additionally, distribution of brochures to pharmacies, schools, and physician offices will be continued.20ReferencesCaraccio, T. R., & McFee, R. B. (2006). Hang up your pocketbook- an easy intervention for the granny syndrome: Grandparents as risk factors in unintentional pediatric exposures to pharmaceuticals. Journal of American Osteopathic Association, 106(71), 405-411. Retrieved from https://fsuvista.ferris.edu:443/webct/urw/lc3282806426071.tp3311107390041/RelativeResourceManager/sfsid/3637652669081(Harvard Medical School 200406 Syrup of ipecac)The Harvard Medical School. (2004, June). Syrup of ipecac. Retrieved from http://www.health.harvard.edu/fhg/updates/update0604a.html

(Pender N Murdaugh C Parsons M A 2011)Pender, N., Murdaugh, C., & Parsons, M. A. (2011). In Health promotion in nursing practice (6th ed., p. ). Upper Saddle River, NJ: Pearson.

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