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Harold K. Simon, MD

Arch Pediatr Adolesc Med. 1999;153:615-618.

Objective  To evaluate caregiver knowledge and delivery of a prescription medication (albuterol) for children.

Design  Prospective convenience sample.

Participants  Caregivers listing albuterol as one of their child's medications.

Setting  Two urban, university-affiliated pediatric emergency departments.

Interventions  Caregivers were asked about their knowledge of the medication, the child's dose, frequency, duration of use, and where it was prescribed. In a mock scenario, they measured and demonstrated medication delivery to their child. Common measuring devices and formulations were offered.

Results  Forty-one caregivers were enrolled. Thirty-six (88%) were high school educated and 39 (95%) had a primary care provider. Twenty-six (63%) were out of medication, 7 (17%) stated an incorrect dose, 18 (44%) reported an incorrect frequency, and 10 (24%) stated an inadequate duration of use. Formulations chosen were liquid (n=15, 37%), nebulizers (n=15, 37%), and inhalers (n=11, 27%). Metered dosing (metered-dosing inhaler or premixed solution) were chosen by 22 caregivers (54%), calibrated measuring tools (droppers, syringes) by 15 (37%), and noncalibrated delivery devices (teaspoon) by 4 (10%). An improper dose was measured by 9 (22%), and the dose intended was inaccurately measured by 7 (17%). All caregivers using a teaspoon inaccurately measured their intended dose of the liquid formulation.

Conclusions  Metered dosing and calibrated measuring devices aided in the accurate delivery of this prescription medication. However, considerable concern exists with the use of noncalibrated measuring devices (teaspoons), improper frequency, and duration of use. Refilling of medication was also a concern since 63% were out of albuterol. Caregiver education on use, delivery, and refilling of medications must be stressed and assessed at all emergency department and primary care visits. In addition, metered dosing and the use of calibrated measuring devices should be encouraged.

From the Department of Pediatrics, Division of Emergency Medicine, Egleston and Hughes Spalding Children's Hospitals, Emory University School of Medicine, Atlanta, Ga.

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