Pediatric emergency medicine trisk 4594 4594
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Medicine as “the degree to which individuals have the capacity to obtain,
process, and understand basic health information and services needed to
make appropriate health decisions.” An estimated 36% of adults have
limited health literacy, which may not be related to years of education or
general literacy. Low health literacy has been related to medication error,
repeat emergency department visits, and morbidity/mortality after
discharge. When reviewing discharge instructions, the practitioner must be
aware of possible health literacy deficits and pay particular attention to
cultural considerations affecting understanding of discharge instructions
and medication instructions, including dosing. The addition of careful
verbal instruction review may help to overcome health literacy disparity.
NONNATIVE ENGLISH-SPEAKING PATIENTS
Nonnative English speakers may be at higher risk of failing to understand
discharge instructions, especially if adequate interpretation services are not
available. Use of a professional interpreter has been associated with greater
odds of caregiver comprehension and complete discharge education
content, including critical aspects such as medication dosing. Instructions,
when possible, should be provided in the native language of the
parent/guardian in written form, or at least reviewed using an interpreter to
verbally translate the most critical aspects of the discharge instructions.
Interpretation services are crucial to allow the family a final opportunity to
clarify any questions they may have prior to discharge.
MEDICATIONS AND MEDICATION RECONCILIATION
Between 12% and 22% of patients do not fill medications prescribed from
an ED visit. Novel approaches such as dispensing medications from the ED
pharmacy, especially during late hours when outpatient pharmacy care is
limited, may help improve medication adherence. Inappropriate dosing and
use of medications are related to health literacy deficits, and are also related
to morbidity and mortality. To help improve medication compliance, names
and instructions for use of new medications should be included in discharge
instructions. Physicians should write in lay terms (e.g., “three times a day”
instead of “TID”). For pediatric dosing, consider marking a syringe to show
the correct liquid dosing or asking a caregiver to demonstrate the correct
way to measure and administer the medication. Any changes to a patient’s
