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TABLE 1

Recommended Provider Counseling Practices to Promote Safe Home Administration of Pediatric Medications

Recommended PracticeExplanation
Provide straightforward and actionable instructions Medication counseling conveys key instructions, including: 
 • Medication name 
 • Medication purpose (indication) 
 • Dose amount 
 • Frequency 
 • Duration 
 • Route of administration 
 • Side effects 
 Provide dose amount using milliliter units only, using the abbreviation “mL." 
 • Avoid spoon-based units (eg, teaspoon [tsp] and tablespoon [TBSP]) 
 • Avoid dosing in cubic centimeters (ie, cc) 
 • Use mL units consistently in verbal and written communication 
 Provide dose amounts that are easy to measure.: avoid fraction or decimal amounts when possible (use whole number amounts); include leading zeros if decimal amounts are used (eg, 0.X); avoid trailing zeros (eg, X.0); and avoid confusing abbreviations, such as U (unit) and QD (daily) (eg, for insulin dosing, spell out the word “unit”). 
 • Avoid fraction or decimal amounts when possible (use whole number amounts) 
 • Include leading zeros if decimal amounts are used (eg, 0.X) 
 • Avoid trailing zeros (eg, X.0) 
 • Avoid confusing abbreviations, such as U (unit) and QD (daily) (eg, for insulin dosing, spell out the word “unit”) 
 Give explicit instructions regarding timing: 
 • Provide information on time of day (eg, in the morning and in the evening) instead of providing only frequency information (eg, 2 times a day) 
 • Include information on explicit timing on prescriptions 
Incorporate health literacy–informed counseling strategies and educational materials for caregivers as part of care provided in inpatient, outpatient, emergency care, and pharmacy settings Use a universal precautions approach to counseling (perspective that all patients would benefit from receiving evidence-based, health literacy–informed communication strategies) 
 Use the following health literacy–informed verbal communication strategies: 
 • Plain, “living room” language 
 • Demonstration (eg, for liquid medications, consider using an oral syringe to demonstrate the amount of medication the caregivers should measure out; for asthma, consider having a staff member demonstrate how to use the spacer with inhaler) 
 • Teachback: ask caregivers to say in their own words how they will give the medication (eg, “I want to make sure I did a good job explaining to you how much medication you should give. Can you tell me how much medication you will give to Jennifer each time?”) 
 • Showback (eg, have caregiver demonstrate how much medication they plan to give each time using an oral syringe). 
 Provide patient- and regimen-specific written instructions that can be taken home and shared with family members: 
 • Incorporate written instructions into verbal counseling to reduce cognitive load 
 • Use pictures and/or drawings to supplement counseling (eg, for liquid medications, provide a pictographic dosing diagram which visually shows the right amount of medication to give within a standard dosing tool) 
 • Provide a log for caregivers to keep track of medications given and help promote adherence to the full course of medication 
 • Written information recommended to be at a sixth- to eighth-grade reading level for the general population and a ≤5th grade reading level for patients with low literacy. 
For liquid medications, promote caregiver use of standard dosing tools • Counsel caregivers to use standard dosing tools (eg, tools with standard measurement markings, such as oral syringes, cups, dosing spoons, and droppers) and avoid the use of nonstandard kitchen spoons. 
 • For prescribed medications, it is recommended that health care providers or pharmacists provide a standard dosing tool to caregivers to take home if no tool is provided as part of packaging (in particular, providers dispensing the medication are responsible for making sure that families have an appropriate tool to use to measure the prescribed medication). 
  ∘ Provide oral syringes when dosing accuracy is important, especially when smaller doses are recommended (eg, <5 mL). 
  ∘ Provide tool with the smallest size to fit the dose without the need to fill the tool multiple times for a single dose. 
 • Warn caregivers regarding potential known pitfalls of dosing cup use. 
  ∘ Avoid cups for smaller doses (eg, <5 mL). 
 ∘ Place cups on a level surface when measuring; look at markings at eye level when measuring. 
 • Promote dosing-tool best practices. 
  ∘ For prescription medications, use tool provided by health care provider or pharmacy for specific medication prescribed. 
  ∘ For OTC medications, use dosing tool included in packaging. 
  ∘ Colocation of dosing tool with prescribed medication. 
Provide language concordant care Verbal counseling and written information should be provided in the language of patient and/or family preference. 
 • High-quality translations should be provided. 
 • Trained/certified professional interpreters should be used. 
Empower caregivers to engage in care • Empower caregivers to ask questions. 
  ∘ Acknowledge that many caregivers have difficulty with administering medications and that questions are expected (eg, “I just gave you a lot of information. It is common for caregivers to have questions about how to give these medications. What questions do you have for me?”) 
 • Encourage caregivers to request a dosing tool if one is not provided. 
Reconcile medications at each relevant patient encounter Conduct regular reviews of medication lists with patients and caregivers. 
 • Systematically review each medication taken (eg, name, strength, indication, dose, frequency, and expected duration) 
 • OTC medications, and vitamins and/or supplements, should be included. 
Recommended PracticeExplanation
Provide straightforward and actionable instructions Medication counseling conveys key instructions, including: 
 • Medication name 
 • Medication purpose (indication) 
 • Dose amount 
 • Frequency 
 • Duration 
 • Route of administration 
 • Side effects 
 Provide dose amount using milliliter units only, using the abbreviation “mL." 
 • Avoid spoon-based units (eg, teaspoon [tsp] and tablespoon [TBSP]) 
 • Avoid dosing in cubic centimeters (ie, cc) 
 • Use mL units consistently in verbal and written communication 
 Provide dose amounts that are easy to measure.: avoid fraction or decimal amounts when possible (use whole number amounts); include leading zeros if decimal amounts are used (eg, 0.X); avoid trailing zeros (eg, X.0); and avoid confusing abbreviations, such as U (unit) and QD (daily) (eg, for insulin dosing, spell out the word “unit”). 
 • Avoid fraction or decimal amounts when possible (use whole number amounts) 
 • Include leading zeros if decimal amounts are used (eg, 0.X) 
 • Avoid trailing zeros (eg, X.0) 
 • Avoid confusing abbreviations, such as U (unit) and QD (daily) (eg, for insulin dosing, spell out the word “unit”) 
 Give explicit instructions regarding timing: 
 • Provide information on time of day (eg, in the morning and in the evening) instead of providing only frequency information (eg, 2 times a day) 
 • Include information on explicit timing on prescriptions 
Incorporate health literacy–informed counseling strategies and educational materials for caregivers as part of care provided in inpatient, outpatient, emergency care, and pharmacy settings Use a universal precautions approach to counseling (perspective that all patients would benefit from receiving evidence-based, health literacy–informed communication strategies) 
 Use the following health literacy–informed verbal communication strategies: 
 • Plain, “living room” language 
 • Demonstration (eg, for liquid medications, consider using an oral syringe to demonstrate the amount of medication the caregivers should measure out; for asthma, consider having a staff member demonstrate how to use the spacer with inhaler) 
 • Teachback: ask caregivers to say in their own words how they will give the medication (eg, “I want to make sure I did a good job explaining to you how much medication you should give. Can you tell me how much medication you will give to Jennifer each time?”) 
 • Showback (eg, have caregiver demonstrate how much medication they plan to give each time using an oral syringe). 
 Provide patient- and regimen-specific written instructions that can be taken home and shared with family members: 
 • Incorporate written instructions into verbal counseling to reduce cognitive load 
 • Use pictures and/or drawings to supplement counseling (eg, for liquid medications, provide a pictographic dosing diagram which visually shows the right amount of medication to give within a standard dosing tool) 
 • Provide a log for caregivers to keep track of medications given and help promote adherence to the full course of medication 
 • Written information recommended to be at a sixth- to eighth-grade reading level for the general population and a ≤5th grade reading level for patients with low literacy. 
For liquid medications, promote caregiver use of standard dosing tools • Counsel caregivers to use standard dosing tools (eg, tools with standard measurement markings, such as oral syringes, cups, dosing spoons, and droppers) and avoid the use of nonstandard kitchen spoons. 
 • For prescribed medications, it is recommended that health care providers or pharmacists provide a standard dosing tool to caregivers to take home if no tool is provided as part of packaging (in particular, providers dispensing the medication are responsible for making sure that families have an appropriate tool to use to measure the prescribed medication). 
  ∘ Provide oral syringes when dosing accuracy is important, especially when smaller doses are recommended (eg, <5 mL). 
  ∘ Provide tool with the smallest size to fit the dose without the need to fill the tool multiple times for a single dose. 
 • Warn caregivers regarding potential known pitfalls of dosing cup use. 
  ∘ Avoid cups for smaller doses (eg, <5 mL). 
 ∘ Place cups on a level surface when measuring; look at markings at eye level when measuring. 
 • Promote dosing-tool best practices. 
  ∘ For prescription medications, use tool provided by health care provider or pharmacy for specific medication prescribed. 
  ∘ For OTC medications, use dosing tool included in packaging. 
  ∘ Colocation of dosing tool with prescribed medication. 
Provide language concordant care Verbal counseling and written information should be provided in the language of patient and/or family preference. 
 • High-quality translations should be provided. 
 • Trained/certified professional interpreters should be used. 
Empower caregivers to engage in care • Empower caregivers to ask questions. 
  ∘ Acknowledge that many caregivers have difficulty with administering medications and that questions are expected (eg, “I just gave you a lot of information. It is common for caregivers to have questions about how to give these medications. What questions do you have for me?”) 
 • Encourage caregivers to request a dosing tool if one is not provided. 
Reconcile medications at each relevant patient encounter Conduct regular reviews of medication lists with patients and caregivers. 
 • Systematically review each medication taken (eg, name, strength, indication, dose, frequency, and expected duration) 
 • OTC medications, and vitamins and/or supplements, should be included. 
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