Medication Teaching
What Parents Should Know
Nadya Nalli, BSc.Phm
Paediatric Academic Multi Organ Transplant Pharmacist
The Hospital for Sick Children
Pharmaceutical Care

Pharmacist
• Accepts that he/she will be directly
responsible to the patient

Patient
• becomes a partner in care rather than
recipient of care
Paediatric Practice

Spectrum
• Neonate  adolescent

Patient & parent/caregiver dynamics
Medication teaching
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Who
Why
When
What
How
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=
=
=
=
audience
purpose
urgency
content
media
WHO? / Audience

Adult vs child
• Learning capacity

Age variant
• Style

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Several theories (adult and child)
Operational stages (Piaget)
Learning Style Inventory
Audience
• Experience/perspective

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Acute vs chronic illness
Cultural differences
• Language

fluency
Audience

Terminology
• common vs medical
• definition of terms
• acronyms/short forms
• familiarity with system
Why? / Purpose


Although essential in disease
management, if taken improperly,
medications can also be the source
of significant morbidity and mortality
Major underlying causes of patient
adverse drug events have been
associated with defects in drug
knowledge dissemination
Purpose

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Non-compliance and drug misadventure are more
likely to occur when patients are prescribed many
medications
Drug misadventure is more likely when patient
medication regimens are changed.
One should not consider possible risks associated
with taking particular medicines in isolation from
the likely beneficial effects. For most people there
will be only a single benefit that is sought, but
the potential risks are often multiple.
Purpose

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Pharmaceutical Care has been the
pharmacist’s approach to improving
medication use
Pharmaceutical care is the
responsible provision of drug therapy
designed to meet a defined outcome
individualized for a specific patient.
When? / Urgency

Stress is a barrier to learning

Prioritize information

Flexibility

Follow-up
What? / Content

Reason for use
• goals of therapy
• time frame of effect

Schedule
• dose time; potential for flexibility
• drug-drug, drug-food, drug-disease
issues
Content

Potential/expected adverse effects
• monitoring at home
• urgency

Management of adverse effects
• plan
Content

Dose Administration
• route (po/pr/ng,gt,jt/topical/sc/iv)
• dose form manipulation
• strategies
• problem solving skills
Content

Drug coverage
• ODB (Trillium/HCP/WF) or private plan
• OOP (out of province) patients
• fiscal year/family cap
• co-pay
• Rx vs OTC
• paperwork (LUF vs. sect 8 approval)
Media

Verbal summary

Verbal + written summaries

Innovative material
• Colour coding
• Braille

Medication schedule
Teaching & Self Medications
6A/4D

Background
• Paediatric Academic Multi-organ
Transplant
• 40+ transplants/year (heart, lung, liver,
kidney and small bowel)
• single or combined
• Deceased donor or living related*
• full organ or split*
Teaching & Self Medications
6A/4D

Philosophy:
• learning occurs in an environment
where safeguards and resources are
available in order to optimize care
• family-centred care
• multi-disciplinary approach
Teaching & Self Medications
6A/4D

Consent
• discuss goals of program with
caregiver(s) and or patient (if age
appropriate)
• obtain written consent; place in chart
• set a time that is mutually convenient
• determine need for interpreter
Teaching & Self Medications
6A/4D

Teaching
• initially didactic (~ 1 hour)
• progression to didactic/interactive
• limit setting by caregiver re: amount of
information given per session
• follow-up sessions as required
• documentation!
Teaching & Self Medications
6A/4D

Medication Summary
• individualized
• includes standard oral/iv medications
• includes name(s), reason for use,
adverse effects and special instructions
Case

7 yr old male; 2 weeks post renal tx
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•
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•
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•
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Tacrolimus 3mg po q12h
Mycophenolate mofetil 250mg po q12h
Prednisolone 5mg po daily
Trimethoprim sulfamethoxazole 60mg po q
daily
Nystatin 100,000u swish/swallow qid
Ganciclovir 150mg iv daily
Magnesium hydroxide 400mg++ po bid
Phosphate sodium 15mmol po bid
Ranitidine 75mg po qhs
Medication Summary for Transplant
Patient, July 2004
Name of Drug
What is it For?
Side Effects
Special Instructions
- take dose on time
Tacrolimus (FK)
(Prograf)
- to prevent rejection
- tremors
- may  blood pressure
- may  magnesium levels
- may  potassium levels
- kidney damage
(dependent on level)
- take with food or juice (no
grapefruit juice) or on an empty
stomach, but always take it the
same way.
- if vomit dose in:
<1/2hr: take again
1/2-1hr: take 1/2 amount
> 1hr: do not need to re-take
*Repeat dose only once*
- if diarrhea tell transplant nurse
- seizure (dependent on
level)
- may cause hair loss
- check with the transplant nurse
first before starting any new
medicine
- 0.5mg, 1mg, 5mg capsules, also
0.5mg/ml HSC suspension that is
stored at room temperature and
must be shaken before each dose
- FK blood levels are measured in
the morning before your morning
dose
Teaching & Self Medications
6A/4D
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Accommodation of Preferences
• dose form (solid vs liquid)
• dose form (size vs volume)
• dose schedule (where applicable)
Teaching & Self Medications
6A/4D

Medication Administration Record
(MAR)
• individualized
• double checked
• updated every shift
• adaptable, where possible
Medication Schedule for Transplant Patient
Time
Medication
8am
Tacrolimus (FK)
Mo Tue We Thu Fri
Sat Sun
(0.5mg/ml susp’)
Mycophenolate
mofetil (MMF)
(100mg/ml susp’n)
Prednisolone
(1mg/ml liquid)
Cotrimoxazole
(8mg TMP/ml susp)
Nystatin
(100,000u/ml susp)
11am
Magnesium
hydroxide
(33mg++/ml susp)
XXX
XXX
XXX
XXX
Teaching & Self Medications
6A/4D

Medications
• individualized
• 7 day supply
• provided in lock box (room temp meds)
• template for optimal storage
Teaching & Self Medications
6A/4D

Drug Plan
• determine type & extent of drug
coverage
• if private, give DINS to parents
• if ODB, identify limited use vs sect. 8 vs
full
• if OOP patient, identify all potential
payors
Teaching & Self Medications
6A/4D

Drug Plan
• explore compassionate supply avenues
• referral to Trillium if required (Ontario
patients only)
• liaise with social worker (if required)
and discharge planner
Teaching & Self Medications
6A/4D

Life Issues
• concomitant/new medications
• alcohol/recreational drug use
• sexual activity
• travel
Teaching & Self Medications
6A/4D

Discharge Prescription - continuity of
care
• ensure appropriate drug/dose
• ensure optimizations/preferences
included
• communicate with outpatient pharmacy
to ensure medication supply, convey
information (patient/caregiver consent)