Abstract

BackgroundSafe medication storage is a proven barrier to ingestions in the pediatric population, but caregivers are often unaware of the importance of safe storage practices or do not have a safe place to store medications. Caregivers may also not be fully aware that the patterns of opioid use and misuse have recently reached crisis levels. The objectives of this study were to define medication storage practices and knowledge of the opioid crisis of participants and to assess the effectiveness of an emergency department intervention on safe medication storage.MethodsThis was a prospective interventional study of caregivers in an urban pediatric emergency department (ED) on safe medication storage and the opioid crisis. Questions assessed the caregivers’ current perceptions and practices related to medication storage and disposal, and opioid crisis awareness. The intervention included verbal instruction about recommended safe storage methods and the opioid crisis, provision of a medication safety handout, and distribution of a medication lock box. A follow-up phone survey conducted 2 weeks later asked participants about use of and satisfaction with the lock box. Frequencies of safe storage behaviors were calculated, and the chi-square statistic was used to compare storage behavior after the intervention.ResultsFifty caregivers of 112 children were enrolled. Only 4% reported they currently stored medications in a locked or latched place. Thirty-eight percent reported their main barrier to storing medications safely was that they did not have a locked or latched storage location. Fifty percent were unaware of the opioid crisis. Ninety-two percent reported they would use a lock box if given one. Twenty-eight participants (56%) responded to the follow-up phone call survey 2 weeks later. At follow up 90% (25/28) reported they placed their medications within the provided lock box (p < 0.00001). Ninety-two percent reported being “very satisfied” with the lock box and how it works.ConclusionsDespite widespread reporting on this issue, many caregivers remain unaware of safe medication storage practices and the opioid crisis. Providing medication lock boxes removes a commonly reported barrier to safely storing medications and improved reported practices.

Highlights

  • Safe medication storage is a proven barrier to ingestions in the pediatric population, but caregivers are often unaware of the importance of safe storage practices or do not have a safe place to store medications

  • Patients 0–19 years old comprised 59% of the 2.1 million calls received by United States (U.S.) Poison Control Centers in 2017, and 77% of all calls that year were for unintentional ingestions (2017 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS) 2018)

  • In our study focused on the safe storage of medications, we found an extreme minority of participants initially reported storing medications in a locked or latched place, and yet most caregivers felt that they were doing enough to prevent their children from accessing their medications

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Summary

Introduction

Safe medication storage is a proven barrier to ingestions in the pediatric population, but caregivers are often unaware of the importance of safe storage practices or do not have a safe place to store medications. Patients 0–19 years old comprised 59% of the 2.1 million calls received by United States (U.S.) Poison Control Centers in 2017, and 77% of all calls that year were for unintentional ingestions (2017 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS) 2018). One 2017 study using a web-based survey tool suggested approximately one third of caregivers with children less than 6 years old and only 11% of caregivers with children 7–17 years old reported safe storage practices (McDonald et al 2017). A 2013 study examining national data from Poison Control Centers and comparing it to the National Center for Health Statistics National Hospital Ambulatory Medical Care Survey (NHAMCS) showed a strong association between national prescribing patterns of opioids with poisonings in children (Burghardt et al 2013). A 2017 study utilized Canadian state databases and reporting systems to show an increased risk of opioid toxicity in children less than 10 years old whose mothers were prescribed opioids (Finkelstein et al 2017)

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