SP5 Parent-led administration of medicine on the neonatal unit
Authors: Murray Sarah , Paize Fauzia , Mullen Rachel , Morecroft Charles 
Published: April 2022

Background

Medication administration is a high risk and error prone task for the trained healthcare professional,1 however, there is little emphasis on training parents how to administer medications until the point of discharge.2–4 The transition from the neonatal unit to home is an anxious and stressful time for parents and ‘one has to question the amount of learning that actually occurs when important information is taught under these circumstances’.2

Aim

Explore current practice and the concept of parent-led administration of medication on the neonatal unit to determine if parents feel adequately prepared for the transition to home.

Method

A case study approach using mixed methods explored the perspectives of neonatal parents and healthcare professionals. The views of both parties on parent-led administration of medication were identified and quantified using a web-based questionnaire, followed by a qualitative virtual focus group. Participants were recruited from a single research site.

Results

A total of 50 neonatal parents participated in the study (44 questionnaire; 6 focus group). Two thirds of questionnaire respondents (65.9%, n=29/44) reported some degree of stress with administering medication, and focus group participants described how inconsistent advice contributed to their stress. Although parents involved with medicine administration were less likely to feel stressed, their involvement was limited to administering pre-measured doses. Two thirds of neonatal parent participants (65.9%, n=29/44) suggested introducing parent involvement early in the neonatal journey.

A total of 64 healthcare professionals participated in the study (60 questionnaire; 4 focus group) which mostly comprised of neonatal nurses (70%, n=42). Despite acknowledging that parents should take an active role in their baby’s care, healthcare professionals expressed concerns around the practicalities and accountability of parents administering doses whilst in the healthcare setting. Just over a quarter said it was safe for parents to administer medicines while on the neonatal unit but that it was dependent on the drug. Healthcare professionals identified that clear guidance was needed to promote change and allay concerns around relinquishing control with the task of medication administration.

Triangulation informed the development of a family-centred protocol for parent-led administration of medication. The protocol provides the neonatal healthcare professionals with a unified and safe approach to parent-led medication administration.

Conclusion

This study established that current practice with medication administration on the neonatal unit is nurse-led and identified a cautious support for parent-led administration of medication from the healthcare professionals. Although the small sample size limits the generalisability of the findings beyond the research site, this study suggests for the first time, a family-centred protocol for parent-led administration of medication that provides a clear framework for healthcare professionals to facilitate parent participation whilst ensuring patient safety. Further research is needed to test the feasibility of the protocol.

References

Nguyen M-NR, Mosel C, Grzeskowiak LE. Interventions to reduce medication errors in neonatal care: a systematic review. Ther Adv Drug Saf 2018;9:123–55.

Griffin T. Applying the principles of family-centered care to the discharge process. J Perinat Neonat Nurs 2006;20:243–9.

Berman L, Raval MV, Ottosen M, Mackow AK, Cho M, Goldin AB. Parent perspectives on readiness for discharge home after neonatal intensive care unit admission. J Pediatr [Internet] 2019;205:98-104.e4. Available at: https://doi.org/10.1016/j.jpeds.2018.08.086

National Health Service (NHS) and Department of Health (DoH). Toolkit for High-Quality Neonatal Services (October 2009) [Internet]. 2009 [cited 2020 Sep 6]. p. 1–106. Available at: http://www.londonneonatalnetwork.org.uk/wp-content/uploads/2015/09/Toolkit-2009.pdf