CME: A Look at Unsupervised Pediatric Drug Exposures

CME: A Look at Unsupervised Pediatric Drug Exposures
Author Information (click to view)

Daniel S. Budnitz, MD, MPH

Director, Medication Safety Program
Division of Healthcare Quality Promotion
Centers for Disease Control and Prevention

Daniel S. Budnitz, MD, MPH, has indicated to Physician’s Weekly that he has or has had no financial interests to report.

Figure 1 (click to view)
Target Audience (click to view)

This activity is designed to meet the needs of physicians.

Learning Objectives(click to view)

Upon completion of the educational activity, participants should be able to:

 

  • Discuss trends in emergency department visits for unsupervised medication exposures among children younger than the age of 6 from 2004 to 2013.

Method of Participation(click to view)

Statements of credit will be awarded based on the participant reviewing monograph, correctly answer 2 out of 3 questions on the post test, completing and submitting an activity evaluation.  A statement of credit will be available upon completion of an online evaluation/claimed credit form at www.akhcme.com/pwJun02.  You must participate in the entire activity to receive credit.  If you have questions about this CME/CE activity, please contact AKH Inc. at dcotterman@akhcme.com.

Credit Available(click to view)

AKH

CME Credit Provided by AKH Inc., Advancing Knowledge in Healthcare

Physicians
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AKH Inc., Advancing Knowledge in Healthcare and Physician’s Weekly’s.  AKH Inc., Advancing Knowledge in Healthcare is accredited by the ACCME to provide continuing medical education for physicians.

 

AKH Inc., Advancing Knowledge in Healthcare designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Commercial Support(click to view)

There is no commercial support for this activity.

Disclosures(click to view)

It is the policy of AKH Inc. to ensure independence, balance, objectivity, scientific rigor, and integrity in all of its continuing education activities. The author must disclose to the participants any significant relationships with commercial interests whose products or devices may be mentioned in the activity or with the commercial supporter of this continuing education activity. Identified conflicts of interest are resolved by AKH prior to accreditation of the activity and may include any of or combination of the following: attestation to non-commercial content; notification of independent and certified CME/CE expectations; referral to National Author Initiative training; restriction of topic area or content; restriction to discussion of science only; amendment of content to eliminate discussion of device or technique; use of other author for discussion of recommendations; independent review against criteria ensuring evidence support recommendation; moderator review; and peer review.

Disclosure of Unlabeled Use & Investigational Product(click to view)

This educational activity may include discussion of uses of agents that are investigational and/or unapproved by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer(click to view)

This course is designed solely to provide the healthcare professional with information to assist in his/her practice and professional development and is not to be considered a diagnostic tool to replace professional advice or treatment. The course serves as a general guide to the healthcare professional, and therefore, cannot be considered as giving legal, nursing, medical, or other professional advice in specific cases. AKH Inc. specifically disclaim responsibility for any adverse consequences resulting directly or indirectly from information in the course, for undetected error, or through participant’s misunderstanding of the content.

Faculty & Credentials(click to view)

FACULTY DISCLOSURES

Keith D’Oria – Editorial Director
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
Daniel S. Budnitz, MD, MPH
Discloses no financial relationships with pharmaceutical or medical product manufacturers:
AKH and PHYSICIAN WEEKLY’S STAFF/REVIEWERS

Dorothy Caputo, MA, BSN, RN- CE Director of Accreditation
Discloses no financial relationships with pharmaceutical or medical product manufacturers.

AKH planners and reviewers have no relevant financial relationships to disclose.

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Daniel S. Budnitz, MD, MPH (click to view)

Daniel S. Budnitz, MD, MPH

Director, Medication Safety Program
Division of Healthcare Quality Promotion
Centers for Disease Control and Prevention

Daniel S. Budnitz, MD, MPH, has indicated to Physician’s Weekly that he has or has had no financial interests to report.

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Research suggests that targeted prevention efforts focusing on harm frequency and intervention feasibility may help further reduce the number of ED visits for pediatric medication exposures.
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About a decade ago, several reports throughout the United States indicated that ED visits were on the rise for unsupervised pediatric medication exposures. “As a result of these studies, clinicians renewed their efforts to improve rates of these exposures,” explains Daniel S. Budnitz, MD, MPH. “Some of the steps were taken included improving safety packaging and increasing education to both healthcare providers and the general public about ways to avoid these exposures. By examining current trends in unsupervised pediatric medication exposures, it’s possible that this data could inform the development of targeted interventions to further reduce the risk of these events.”

 

Long-Term Trends

For a study published in Pediatrics, Dr. Budnitz and colleagues examined data from the National Electronic Injury Surveillance System–Cooperative Adverse Drug Event Surveillance project to assess trends in ED visits for unsupervised medication exposures among children younger than the age of 6 from 2004 to 2013. The investigators also identified the dosage form and prescription status of implicated medications from 2010 through 2013.

The authors found that approximately 640,000 children were seen in the ED for ingesting drugs between 2004 and 2013. About 70.0% of these children were aged 1 or 2, and nearly 20.0% of this group was hospitalized. The number of pediatric ED visits for unsupervised medication exposures increased by an average of 5.7% annually during the early 2000s and peaked at about 76,000 visits in 2010. After 2010, however, this trend reversed, with the number of ED visits decreasing by an average of 6.7% per year to approximately 59,000 visits in 2013. “While the decreasing trend is encouraging, this figure is still too high,” Dr. Budnitz says.

 

Common Culprits

Between 2010 and 2013, the research team found that 91.0% of ED visits for unsupervised medication exposures involved ingestion of one drug. The most common of these scenarios (45.9%) involved an oral solid prescription that was available in pill, tablet, or capsule form. In total, more than 260 different prescription solids were implicated in the study. The most common included narcotics (13.8% of visits), such as buprenorphine, oxycodone, or hydrocodone, and benzodiazepines (12.7% of visits), including clonazepam and alprazolam.

Oral over-the-counter (OTC) solid medications (22.3%) and oral OTC liquids (12.4%), such as cough syrups, were other drugs of ingestion commonly involved in unsupervised medication exposures. “Four medications—acetaminophen, cough and cold medicines, ibuprofen, and diphenhydramine—caused more than 91.0% of emergency room visits for OTC liquid medication exposures,” says Dr. Budnitz (Table). In 87.0% of these cases, the medication was a child or infant version of the drug.

 

More Work Needed

Dr. Budnitz notes that clinicians must still be vigilant about striving to reduce pediatric unsupervised medication exposures. Recent efforts by physicians to warn parents to keep medications out of the reach of children and by manufacturers to add new child-resistant features in packaging appear to be helping decrease risks for unsupervised medication exposures, but there is still room for improvement. “These exposures are preventable, but the key is to ensure that parents take precautions,” Dr. Budnitz says.

 

Working With Parents

According to Dr. Budnitz, caregivers should instruct parents of young children to keep all medications in a safe location that is too high for them to reach or see. Parents should also be instructed to always relock safety caps on drug bottles and return all medications to a safe storage location after each use. Another important step is to avoid telling children that medication tastes like candy or something good in order to get them to take it.

In addition to these steps, parents should be encouraged to remind family members, babysitters, and other visitors of their homes to keep purses, bags, or coats that have medications in them out of sight and reach when they come to the house. Medications should also be kept in the original child-resistant containers whenever possible because some containers, such as pill organizers or plastic bags, lack child safety features and can be easily opened. Another simple strategy is to have parents program the Poison Help number in their home and cell phones to have it handy should it be needed.

“Ultimately, physicians should recognize that we have a role in this problem,” says Dr. Budnitz. “We need to develop targeted prevention efforts based on the frequency of harm and design feasible interventions to help continue reducing the number of ED visits for pediatric medication exposures. The process has already started with small steps. For example, electronic health records now mandate that liquid formulation medications be dosed in milliliters rather than teaspoons, tablespoons, or some other measurement. This can help with unintentional overdoses from parents. However, other innovative approaches, such as improved safety packaging and targeted educational messages, may be necessary to continue the declines we’ve seen in recent years.”

 

Readings & Resources (click to view)

Lovegrove MC, Weidle NJ, Budnitz DS. Trends in emergency department visits for unsupervised pediatric medication exposures, 2004-2013. Pediatrics. 2015 Sep 7 [Epub ahead of print]. Available at: http://pediatrics.aappublications.org/content/early/2015/09/01/peds.2015-2092.abstract.

Lovegrove MC, Mathew J, Hampp C, Governale L, Wysowski DK, Budnitz DS. Emergency hospitalizations for unsupervised prescription medication ingestions by young children. Pediatrics. 2014;134:e1009-e1016.

Budnitz DS, Lovegrove MC, Rose KO. Adherence to label and device recommendations for over-the-counter pediatric liquid medications. Pediatrics. 2014;133:e283-e290.

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