Foster Caregiver Experience of Pediatric Hospital-to-Home Transitions: A Qualitative Analysis

Martens, Anna; DeLucia, Michael; Leyenaar, JoAnna K.; Mallory, Leah

doi:10.1016/j.acap.2018.06.007

Cited by 7 publications

(3 citation statements)

References 18 publications

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“…Our findings do align with 2 recent studies demonstrating that children discharged from hospital into foster care experience a number of challenges at the time of hospital discharge, including poor communication between DCF, the hospital, and the children's caregivers; inconsistent discharge processes; and increased odds of caregiver misunderstandings about children's postdischarge care needs. 25,26 Children in foster care may move multiple times to different families and cities, initially complicating the EI referral process. A recent study by Merhar et al 10 suggested that children who remained in foster/adoptive care scored higher on cognitive testing at 2 years of age.…”

Section: Discussionmentioning

confidence: 99%

“…Recognizing that children discharged from hospital and into foster care may experience a number of challenges during the hospital-tohome transitions, understanding how EI referral and enrollment patterns differ among infants with NAS who are discharged into foster care is particularly important. 25,26 We conducted a retrospective cohort study using maternal and infant hospital birth records from 1 tertiary care academic children's hospital in Western Massachusetts, linked with EI enrollment data, to characterize enrollment patterns and to identify factors associated with EI enrollment among mother-infant dyads affected by NAS. We hypothesized that infant enrollment in EI would be positively associated with (1) retained maternal custody of her infant at the time of hospital discharge, (2) maternal receipt of medication-assisted treatment, and (3) maternal abstinence from illicit drugs during pregnancy, with all 3 of these factors representing the stability of the mother's recovery from OUD or the overall functional assessment of the family home environment that is also conducive to recovery.…”

Section: Index Termsmentioning

confidence: 99%

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Early Intervention Referral and Enrollment Among Infants with Neonatal Abstinence Syndrome

Peacock-Chambers

Leyenaar

Foss

et al. 2019

J Dev Behav Pediatr

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Objective: To identify factors associated with referral and enrollment in early intervention (EI) for infants with neonatal abstinence syndrome (NAS). Methods: We conducted a retrospective cohort study of 256 infants born with NAS (2006-2013) at a tertiary care hospital in (Springfield), Massachusetts, linking maternal-infant birth hospitalization records with Department of Public Health EI records. We calculated the percent of infants retained at each step in the EI enrollment process over the first 3 years of life. We conducted separate multivariable logistic regression analyses to identify factors associated with EI referral and enrollment. Results: Among mothers, 82% received medication-assisted treatment at delivery, 36% endorsed illicit drug use during pregnancy, and 76% retained custody of their child at discharge. Among infants, 77% were referred to EI and 48% were enrolled in services. Of infants discharged to biological parents, 81% were referred to EI versus 66% of infants discharged to foster care (p ≤ 0.05); this difference persisted in multivariable analysis [adjusted odds ratio, 2.30; 95% confidence interval (CI), 1.09-4.86]. Infants in the highest tertile for length of stay had 2.70 times the odds of EI enrollment (95% CI, 1.37-5.31). Conclusion: Fewer than half of the eligible infants with NAS were enrolled in EI services. Discharge to a biological parent and longer hospital stay had the strongest associations with EI referral and enrollment, respectively. Efforts to improve EI referral rates during the birth hospitalization, particularly among infants discharged into foster care, and close follow-up for

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Section: Discussionmentioning

confidence: 99%

Section: Index Termsmentioning

confidence: 99%

Early Intervention Referral and Enrollment Among Infants with Neonatal Abstinence Syndrome

Peacock-Chambers

Leyenaar

Foss

et al. 2019

J Dev Behav Pediatr

Self Cite

View full text Add to dashboard Cite

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“…Other causes of the lower number of UDs identified in this study were related to the profile of acute health conditions, i.e., most patients did not use medicines at home. In contrast, previous studies revealed lower rates of UDs in hospitals that implemented medication reconciliation [27][28][29]. For example, in a discharge study from a pediatric hospital in London, 33% (47 of 142) of patients had at least one discrepancy [28].…”

Section: Discussionmentioning

confidence: 79%

Medication Discrepancies Involving Hospitalized Children At A High-Complexity Public Hospital

Lyra-Jr

Alcântara

Neto

et al. 2019

Preprint

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Background: Children are more susceptible to medication errors and adverse reactions. In addition, variation in body mass and medication discrepancies are the major causes of medication errors, which pose a risk of harm to children. When unresolved, these issues can lead to longer hospital stays, increased hospital readmissions, and emergency room care that burden the healthcare system. Many organizations have struggled to implement medication reconciliation. In this context, studies demonstrated that reliability and improvement science methods can be used to implement a successful and sustained medication reconciliation process. One of the initial steps involved in medication reconciliation process is determining the sector for implementation. Therefore, the aim of this study was to determine the prevalence of medication discrepancies occurring throughout the course of a hospital stay and describe the types of discrepancies and medications most commonly involved in pediatric cases. Methods: A cross-sectional study was carried out from July 2017 to March 2018 in the pediatric department of a high-complexity public hospital in Brazil. Data collection consisted of: collection of sociodemographic data, clinical interview with the patient's caregiver, registration of patient prescriptions, and evaluation of medical records. Discrepancies were classified as intentional or unintentional and included omission of medication, therapeutic duplicity, different dose, frequency, route of administration than prescribed. Study approved by the Research Ethics Committee (CAAE: 36927014.4.0000.5546). Results: During care transitions, 114 children were followed. Patients presented unintentional discrepancies, of which 16 (14.0%) presented discrepancies at hospital admission, 42 (36.8%) during ward transfer, and 52 (45.6%) during discharge. Omission represented 74% (n=20) ofthe errors at admission, 38% (n=26) at ward transfer, and 100% (n=80) at discharge. The most frequent discrepancies in the three transitions were related to antimicrobials, representing 43.3% of discrepancies at admission, 38.8% at internal transfer, and 61.2% during discharge. Conclusion: The results demonstrated that the main transition levels when unintentional discrepancies occurred in children in this hospital were during internal transfer and discharge and indicated difficulties in interprofessional communication and poor documentation. Evaluation of all transition points is essential for determining the most critical point in the quality of care provided at hospitals.

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Prevalence of medication discrepancies in pediatric patients transferred between hospital wards

et al. 2020

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Foster Caregiver Experience of Pediatric Hospital-to-Home Transitions: A Qualitative Analysis

Cited by 7 publications

References 18 publications

Early Intervention Referral and Enrollment Among Infants with Neonatal Abstinence Syndrome

Early Intervention Referral and Enrollment Among Infants with Neonatal Abstinence Syndrome

Medication Discrepancies Involving Hospitalized Children At A High-Complexity Public Hospital

Prevalence of medication discrepancies in pediatric patients transferred between hospital wards

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