• Alexander F Glick, Jonathan S Farkas, Joseph Nicholson, Benard P Dreyer, Melissa Fears, Christopher Bandera, Tanya Stolper, Nicole Gerber, and H Shonna Yin.
• New York University School of Medicine, New York, New York; and alexander.glick@nyumc.org.
• Pediatrics. 2017 Aug 1; 140 (2).

ContextParents 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.ObjectiveTo perform a systematic review of the literature related to parental management (knowledge and execution) of inpatient and ED discharge instructions.Data SourcesWe consulted PubMed/Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, and Cochrane CENTRAL (from database inception to January 1, 2017).Study SelectionWe selected experimental or observational studies in the inpatient or ED settings in which parental knowledge or execution of discharge instructions were evaluated.Data ExtractionTwo authors independently screened potential studies for inclusion and extracted data from eligible articles by using a structured form.ResultsSixty-four studies met inclusion criteria; most (n = 48) were ED studies. Medication dosing and adherence errors were common; knowledge of medication side effects was understudied (n = 1). Parents frequently missed follow-up appointments and misunderstood return precaution instructions. Few researchers conducted studies that assessed management of instructions related to diagnosis (n = 3), restrictions (n = 2), or equipment (n = 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, n = 5; inpatient, n = 0).LimitationsThe studies were primarily observational in nature.ConclusionsParents 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.Copyright © 2017 by the American Academy of Pediatrics.

11 keywords...

hide…