Parents as Partners in Obtaining the Medication History

S. C. Porter
2005 JAMIA Journal of the American Medical Informatics Association  
A b s t r a c t Objective: Patient-centered information management may overcome barriers that impede highquality, safe care in the emergency department (ED). The utility of parents' report of medication data via a multimedia, touch screen interface, the asthma kiosk, was investigated. Our specific aims were (1) to estimate the validity of parents' electronically entered medication history for asthma and (2) to compare the parents' kiosk entries regarding medications to the documentation of ED
more » ... ysicians and nurses. Methods: We enrolled a cohort of parents to use the asthma kiosk and tested the validity of this communication channel for medication data specific to pediatric asthma. Parents' data provided via the kiosk during the ED encounter and the documentation of ED nurses and physicians were compared with a telephone-based interview with the parent after discharge that reviewed all asthma-specific medications physically present in the home. Treating clinicians in the ED were blinded to the parents' kiosk entries. Results: Sixty-six parents were enrolled and 49 of 66 (74.2%) completed the gold standard interview. When analyzed at the level of individual medications, the validity of parental report was 81% for medication name, 79% for route of delivery, 66% for the form of the medication, and 60% for dose. Parents' report improved on the validity of documentation by physicians across all medication details save for medication name. Parents' report was more valid than nursing documentation at triage for all medication details. Conclusion: Parents can provide an independent source of medication data that improves on current documentation for key variables that impact quality and safety in emergency asthma care. j J Am Med Inform Assoc. 2005;12:299-305. Complete and accurate knowledge of a patient's history is essential to safe and effective health care delivery. Information systems such as computerized provider order entry, which improve the quality of delivered care, depend on the electronic availability of valid data in key domains such as medication history and allergy history. Initial capture of data elements in these domains must occur through human effort at discovery and documentation. No evidence-based consensus exists for how best to populate critical domains of knowledge and validate the capture of patient-specific data at the point of entry for a patient in a health care environment. The emergency department (ED) represents an archetype of a health care setting at risk of gaps in quality and safety as defined by the Committee on Data Standards of the Institute of Medicine: multiple providers involved in the care of individual patients, high acuity, a setting prone to distractions from noise and crowding, need for rapid decision-making, and communication barriers. 1,2 The ED functions as an important safety net and site of care for large numbers of patients. 2 In particular, ED visits for patients with asthma are considered a sentinel event and an opportunity for intervention to improve disease management. 3 National guidelines for pediatric asthma require that a patient's symptoms and current medication regimen be evaluated to establish whether optimal chronic control has been achieved. 4 Previous research in ED-based pediatric asthma care demonstrates important gaps in quality of history taking. 5 A novel patient-centered technology, the asthma kiosk, was recently developed for parents' use in the pediatric ED to provide relevant data concerning childhood asthma. 6 This multimedia, touch screen kiosk provides an electronic method to capture parents' knowledge regarding their child's asthma
doi:10.1197/jamia.m1713 pmid:15684127 pmcid:PMC1090461 fatcat:3horc3oanza3bmt4yquozhsumq