Parental Management of Discharge Instructions: A Systematic Review

Parents often manage complex instructions when their children are discharged from the inpatient setting or emergency department (ED); misunderstanding instructions can put children at risk for adverse outcomes. Parents' ability to manage discharge instructions has not been examined before in a...

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Bibliographic Details
Published in:Pediatrics (Evanston) 2017-08, Vol.140 (2)
Main Authors: Glick, Alexander F, Farkas, Jonathan S, Nicholson, Joseph, Dreyer, Benard P, Fears, Melissa, Bandera, Christopher, Stolper, Tanya, Gerber, Nicole, Yin, H Shonna
Format: Article
Language:English
Subjects:
Admission and discharge
Child
Child, Hospitalized
Children
Children & youth
Company business management
Discharge
Emergency medical services
Emergency service
Emergency Service, Hospital
Health Knowledge, Attitudes, Practice
Health Literacy
Hospital admission and discharge
Hospital emergency services
Hospitals
Humans
Literature reviews
Management
Nursing
Parental responsibilities
Parents
Parents & parenting
Patient Discharge
Pediatrics
Review
Reviews
Risk management
Systematic review
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Summary:Parents often manage complex instructions when their children are discharged from the inpatient setting or emergency department (ED); misunderstanding instructions can put children at risk for adverse outcomes. Parents' ability to manage discharge instructions has not been examined before in a systematic review. To perform a systematic review of the literature related to parental management (knowledge and execution) of inpatient and ED discharge instructions. We consulted PubMed/Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, and Cochrane CENTRAL (from database inception to January 1, 2017). We selected experimental or observational studies in the inpatient or ED settings in which parental knowledge or execution of discharge instructions were evaluated. Two authors independently screened potential studies for inclusion and extracted data from eligible articles by using a structured form. Sixty-four studies met inclusion criteria; most ( = 48) were ED studies. Medication dosing and adherence errors were common; knowledge of medication side effects was understudied ( = 1). Parents frequently missed follow-up appointments and misunderstood return precaution instructions. Few researchers conducted studies that assessed management of instructions related to diagnosis ( = 3), restrictions ( = 2), or equipment ( = 1). Complex discharge plans (eg, multiple medicines or appointments), limited English proficiency, and public or no insurance were associated with errors. Few researchers conducted studies that evaluated the role of parent health literacy (ED, = 5; inpatient, = 0). The studies were primarily observational in nature. Parents frequently make errors related to knowledge and execution of inpatient and ED discharge instructions. Researchers in the future should assess parental management of instructions for domains that are less well studied and focus on the design of interventions to improve discharge plan management.
ISSN:0031-4005
1098-4275
DOI:10.1542/peds.2016-4165