2 Kelly Ma, BScPharm, was a pharmacy student at the University of British Columbia, and is now a community pharmacist in Vancouver.
Unique Subheading 1
3 Pia DeZorzi, BScN, RN, CPON, is Professional Practice Leader at BC Children’s Hospital in Vancouver.
Unique Subheading 2
4 Don Hamilton, BScPharm, is Clinical Coordinator at Children’s and Women’s Health Centre in Vancouver.
- Author information
- Copyright and License information
1 Jennifer G Kendrick, BScPharm, PharmD, is a Clinical Pharmacist at Children’s and Women’s Health Centre in Vancouver.
2012 Canadian Society of Hospital Pharmacists. All content in the Canadian Journal of Hospital Pharmacy is copyrighted by the Canadian Society of Hospital Pharmacy. Authors transfer all copyright ownership to CSHP.
Unique Heading 1
Unique Subheading 3
During the study, the pediatric hospital had no policy for handling vomiting after oral medication ingestion, and limited literature was available.
Unique Subheading 4
The study aimed to understand the clinical issue of vomiting after medication intake and gather opinions from health professionals at various pediatric hospitals.
Unique Subheading 5
Online surveys were conducted to collect information on current practices and opinions of pediatric health care professionals regarding redosing medications after vomiting.
Unique Subheading 6
Out of 76 responses from the study hospital, 65 were analyzed. Respondents reported encountering vomiting after oral medication frequently, with factors like time after ingestion and medication type being crucial.
Unique Subheading 7
Vomiting after oral medication was a common issue at the study hospital with limited guidelines in other pediatric institutions. The time between ingestion and vomiting was a key factor in redosing decisions.
Keywords: vomiting, pediatric, oral medication, survey
Unique Heading 2
Unique Subheading 8
At the time of the study, the authors’ pediatric hospital lacked a policy on handling vomiting post oral medication intake, with limited information available in literature.
Unique Subheading 9
The goal was to characterize this clinical problem, identify current practices for redosing medications, and gather opinions from health professionals in other pediatric hospitals.
Unique Subheading 10
Two online surveys were conducted to assess current practices and opinions of pediatric health care professionals on redosing medications after vomiting.
Unique Subheading 11
Analysis revealed that the problem of vomiting after oral medication intake was prevalent at the study hospital, highlighting the significance of time between ingestion and vomiting in redosing decisions.
Unique Subheading 12
Vomiting post oral medication was a common issue at the hospital, with limited guidelines at other pediatric institutions. The time between ingestion and vomiting was deemed crucial in medication redosing decisions.
[Translated by the editor]
Keywords: vomiting, children, oral medications, survey
Unique Heading 3
Vomiting is a common occurrence in hospitalized children, and its significance post oral medication intake varies.
Literature lacks guidance on managing vomiting after oral medication intake, encouraging case-by-case decisions for redosing medications.
It is important for healthcare providers to assess the underlying cause of vomiting in children, such as gastrointestinal issues, medication side effects, or other medical conditions. It is also crucial to monitor hydration status and electrolyte levels in these patients to prevent complications from vomiting.
The surveys revealed that there is a lack of consensus among health care professionals regarding redosing oral medications after vomiting. While some believe it is necessary to redose to ensure the patient receives the full dose of medication, others are concerned about potential overdose or adverse effects.
Factors that were rated as important in the decision to redose included the type of medication, the time elapsed since the initial dose, and the patient’s age and weight. Guidelines varied among hospitals, with some having strict protocols in place while others relied on individual judgment.
Overall, the surveys highlighted the need for clear guidelines and standardized practices regarding redosing oral medications after vomiting in pediatric patients. Further research and collaboration among healthcare professionals are necessary to ensure the safety and efficacy of pediatric medication administration.
Unique Heading 5
Unique Subheading 13
Out of 76 responses from C&W professionals, 65 were included in the analysis, with nurses being the majority of respondents.
Table 1
Characteristics of Respondents to Survey of Health Care Professionals at C&W Hospital of British Columbia
| Features | Number (%) of Participants* (n=65) |
|---|
The majority of participants reported experiencing vomiting after taking oral medications. Most of them would consider taking another dose based on the time that has passed since the initial ingestion and the presence of medication in the vomitus. Factors such as the time elapsed after taking the medication, the type of medication, the condition of the patient, and the visibility of the medication in the vomit were considered to be highly important when deciding whether to redose oral medications after vomiting.
Table 2.
Significance of Factors Influencing the Decision to Redose an Oral Medication after Vomiting among Healthcare Professionals at Children’s and Women’s Hospital of British Columbia
| Factor | Percentage of Participants who Considered it Very Important | Average Importance Rating |
|---|
| Time since taking the dose | 59 (91) | 4.8 ± 0.8 |
| Type of medication | 45 (69) | 4.6 ± 0.9 |
| Patient’s condition | 39 (60) | 4.3 ± 1.0 |
| Detectability of medication in vomit | 36 (55) | 4.2 ± 1.1 |
| Medical professional’s knowledge about the medication | 26 (40) | 3.8 ± 1.3 |
| Form of dosage | 22 (34) | 3.7 ± 1.2 |
| Amount of vomit | 16 (25) | 3.6 ± 1.2 |
| Patient’s age | 8 (12) | 2.6 ± 1.3 |
Standard Deviation is denoted as SD.
5 out of 5 points were given on the Likert scale.
Assessment was done using a 5-point Likert scale, where 1 signifies low importance and 5 signifies high importance.
While most participants had come across similar situations before, only 12 had encountered the most recent one. Over 60% made the same decision on medication redosing for each scenario. The crucial factor was the time lapse after ingestion, with least consideration given to patient age. The impact of medication type varied depending on the scenario, especially notable with long-acting morphine.
Table 3.
Overview of Characteristics and Reactions to 6 Clinical Scenarios from Survey Conducted among Healthcare Professionals in a Hospital Setting
| Circumstances | Number (%) Would Require Additional Dose | Number (%) Factors Influencing Clinical Decision | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Case No. | Age (years) | Medication and Treatment Plan | Time until Vomiting (minutes) | Appearance in Vomit | Yes | No | Uncertain | Duration after Initial Dose | Age of Patient | Type of Medication |
| Experiment | Duration | Treatment | Age | Pain Relief | Mild Pain | Moderate Pain | Severe Pain | Excellent Response | Good Response | Poor Response |
| 1 (n = 63) | 10 | Prednisone once daily | 30 | None | 16 (25) | 40 (63) | 7 (11) | 58 (92) | 5 (8) | 37 (59) |
| 2 (n = 63) | 10 | Prednisone once daily | > 60 | None | 0 (0) | 61 (97) | 2 (3) | 61 (97) | 2 (3) | 18 (29) |
| 3 (n = 59) | 10 | Prednisone once daily | 30 | Partial | 38 (64) | 11 (19) | 10 (17) | 47 (80) | 3 (5) | 35 (59) |
| 4 (n = 58) | 2 | Prednisone once daily | 30 | None | 14 (24) | 35 (60) | 9 (16) | 53 (91) | 16 (28) | 35 (60) |
| 5 (n = 57) | 10 | Acetaminophen q6h PRN | 30 | None | 8 (14) | 42 (74) | 7 (12) | 45 (79) | 11 (19) | 34 (60) |
| 6 (n = 57) | 10 | Long-acting morphine bid | 30 | None | 4 (7) | 42 (74) | 11 (19) | 42 (74) | 4 (7) | 47 (82) |
Survey of Practitioners at Other Pediatric Hospitals
Out of 53 responses received from various institutions, 47 were complete and included in the analysis, while 6 were partially included.
A recent survey revealed that 30% of respondents working in pediatric hospitals had established guidelines for managing vomiting following the administration of oral medications. The majority of these guidelines were specific to a particular ward or service, with some being hospital-wide or focused on certain drugs. Only 3 guidelines had references attached to them. On the other hand, 70% of respondents reported a lack of guidelines in their facilities, resorting to practices like redosing within a specific timeframe, utilizing professional judgment, or consulting the prescriber.
Table 4.
Key factors in the guidelines of pediatric institutions included the time since ingestion of the dose, the type of medication, visibility of medication in vomit, the form and volume of vomit, and the age of the patient.
Despite 75% of respondents facing challenges with vomiting after administering oral medications, there is a scarcity of evidence-based recommendations regarding redosing. Most guidelines considered factors such as the time since ingestion, medication type, and visibility in vomit. Clinical judgment was also a significant influencer in decision-making. The complexity of providing a specific course of action is attributed to the diversity among patients and the variable nature of medications.
The survey had its limitations, like possible recall bias and design flaws, such as the lack of provision for written answers. Future research recommendations include surveying prescribers, addressing knowledge gaps, and fulfilling training needs.
DISCUSSION
The research findings indicated that healthcare professionals often take into account the timing of vomiting and the type of medication when considering re-administering a vomited medication. Clinical judgment is a crucial factor in this decision-making process.
CONCLUSIONS
Healthcare professionals at the authors’ institution noted encountering the issue of post-medication vomiting on a weekly or monthly basis. This problem predominantly occurred in children aged 4 or below. Factors like the time elapsed since dose ingestion, medication type, patient condition, and medication visibility in vomit were significant in determining the need for readministering the medication.
Less than one-third of healthcare professionals from other institutions had established guidelines for such situations. These guidelines typically focused on the time between dose ingestion and vomiting, medication type, and visibility in vomit. Professionals without guidelines relied on elapsed time or their professional judgment.
The decision regarding re-administration involves a careful balance between the risk of treatment failure and the potential for toxic effects. Pediatric inpatients may require decisions tailored to their specific circumstances, but having a decision-making algorithm or a list of factors could prove beneficial. Plans for education and guidance documents are in place for the authors’ pediatric institution.
References
Articles from The Canadian Journal of Hospital Pharmacy are made available here through the gracious courtesy of the Canadian Society of Healthcare-Systems Pharmacy