Hospital Pharmacy - December 2020 - 407

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Chew et al	
Table 1.  Characteristics of Respondents and Their Children.

Table 2.  Themes and Subthemes Generated.

Characteristics

Theme

Respondents (n = 15)
  Age, median (IQR)
 Gender
  Female
  Male
  Education level
  Primary
  Secondary
  Pre-university/
certificate/diploma
   Degree or above
Children (n = 15)
  Age, median (IQR)
  Duration of treatment
(month), median (IQR)
  Type of chronic disease
  Asthma
  Epilepsy
  Hypothyroidism
  Thalassemia
  Nephrotic syndrome
  Chronic eczema
   Tetralogy of Fallot
  Number of medications
  1
  2
  3

n (%)
34 (5)

I. Actual experiences
with medication
errors

15 (100.0)
0 (0.0)
0 (0.0)
9 (60.0)
3 (20.0)

II. Underlying
risk factors for
medication errors

3 (20.0)
3.67 (3.67)
23 (45)
 
3 (20.0)
3 (20.0)
3 (20.0)
3 (20.0)
1 (6.7)
1 (6.7)
1 (6.7)
8 (53.3)
4 (26.7)
3 (20.0)

Note. IQR = interquartile range.

unintentionally. Some of the errors were also found to have
affected the treatment outcomes.
Wrong medication preparation methods.  A few of the respondents admitted that they had been making errors in medication preparation which had a clear impact on the control of
their children's conditions until they received the correct
information from the health care providers.

III. Recommendations
to improve
medication safety

Subtheme
Wrong medication preparation methods
Overdosing
Missed or incomplete doses
Self-decided treatment discontinuation
Self-decided dose adjustment
Limited understanding about
medications
Confusion over instructions
Confusion over measurement units
Uncertainty about re-administration
following vomiting
Lack of reassessment by health care
professionals
Barriers to communication between
caregivers and health care providers
More information from health care
providers
Continuity of care
The use of written instructions and
diaries

After all, I still decided to give it (the medication) to my child
even though it was a wrong dose. (T03, 27 years old, mother of
a child with hypothyroidism)

Overdosing also occurred when the respondents did not
fully understand the method of using certain devices, such as
metered-dose inhalers (MDIs) and aerochambers.
I did not clearly hear the sound (when pressing the MDI) . . . I
felt that the medication was not released (into the aerochamber),
so I just press (the MDI) again. (A01, 32 years old, mother of a
child with asthma)

Missed or incomplete doses. Moreover, missed doses were
found to be common and mainly unintentional, while the
caregivers generally had a busy work life and occasionally
relied on their partners for medication administration.
When my child was with him (the father), the (administration
of) medication was always forgotten. (S01, 34 years old, mother
of a child of thalassemia)

Yes, I had been doing it (medication preparation) wrongly by
dissolving the medications in hot water. The doctor detected my
error and told me that I should use warm water instead. Her (my
daughter's) condition has become better since I started to
dissolve the medications in warm water. (T01, 34 years old,
mother of a child with hypothyroidism)

Some of the respondents decided to skip a dose when they
were occupied with work.

Overdosing.  Some of them also admitted that they had experiences of unintentionally giving extra doses of medications to
their children.

Rather than three times a day, I only gave (the medications to my
child) two times a day when I was busy. (O02, 36 years old,
mother of a child with chronic eczema)

I should have alternated between 1 and 1½ tablets on an everyother-day basis . . . I realized that I had dissolved ½ tablet more
(in the water) on the day when only 1 tablet was required . . .

Occasionally, some children were also reported to be
uncooperative, resulting in the administration of an incomplete dose.
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