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Table 3.  Recommendations to Improve Medication Safety at Home.
Issues of home medication safety identified
Medication-related issues
  Wrong medication preparation methods
  Dosing error
  Lack of age-adapted drug dosage forms
Caregivers-related issues
  Inadequate knowledge about the
medications
  Unintentional missed doses
  Intentional medication errors
  Working mothers
Health care providers-related issues
  Conflicting instructions from the health
care providers

Recommendations for improvement
Keeping a medication record and administration diary
Keeping a medication record and administration diary
Research initiatives to explore for pharmaceutical dosage forms that are
suitable for children of different ages
Standardized informative written instructions that serve as a guide for
communicating about medication-related information with the caregivers
** Keeping a medication administration diary
** Environmental support: use of technologies, such as a mobile application
** Determine the causes of the wrong belief about the drug treatment at
an individual level
** Educate caregivers about the importance of medication adherence
Health care providers could engage the father in disease management and
medication administration
Standardized informative written instructions that serve as a guide for
communicating about medication-related information with the caregivers

As highlighted by the caregivers, informative written
instructions could serve as a guide for health care providers
when communicating the medication-related information
with the caregivers. The confusion about conflicting instructions from the health care providers could also be avoided, as
standardized information, including the name of a medication, dosage, and common side effects, is provided. To ensure
the consistency of the verbal instructions provided by pharmacists, a standard protocol is also required to guide the
pharmacists in medication counseling.2,15,22 In addition, a
diary which keeps track of the medication administration
activities could be helpful in preventing missed doses besides
reducing overprescribing of medications.2,16 Table 3 summarizes recommendations to improve medication safety at
home.

the medications among the caregivers. The underlying risk
factors which could compromise the medication safety at
home primarily originated from inadequate knowledge about
the medications and confusion over the instructions. While
children were shown to be consistently exposed to medication errors at home in Malaysia, the recommendations of the
caregivers, including the use of written instructions by the
health care providers and keeping a medication administration diary, could be effective strategies to improve the out-ofhospital medication safety in children.
Authors' Note
Not commissioned; externally peer reviewed. For confidentiality
reasons, qualitative data collected for this study cannot be shared.

Acknowledgments

Study Limitation
This was a single-center study, and the issues highlighted by
the caregivers could be center-specific. As the study was conducted in a tertiary hospital, the findings were also not necessarily reflective of the conditions in other health settings. In
addition, all the respondents recruited were mothers, and
therefore further investigation into father-specific issues in
medication handling and administration could be considered.

Conclusions
The findings indicate that medication errors have been made
by caregivers of children in Malaysia, either intentionally or
unintentionally. Unintentional errors were mainly due to
unclear instructions and difficulty in remembering the time
for medication administration, while intentional errors were
attributable to a busy working life and a negative belief about

We would like to thank the Director General of Health, Malaysia,
for his permission to publish this article. Ethical approval was
obtained from Medical Research Ethical Committee (MREC) via
registration with National Medical Research Registry (NMRR).
NMRR registration number: NMRR-18-228-40047 (IIR). Informed
consent was obtained from caregiver prior data collection and they
could withdraw from the study at any time should they wish to.

Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.

Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD
Chii-Chii Chew

https://orcid.org/0000-0002-9316-3671
https://www.orcid.org/0000-0002-9316-3671
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