Archive for the ‘workshops’ category

Promoting medication safety in community spaces

November 22, 2009

In our outreach to parents of children under 6, we have visited different community groups to promote medication safety with respect to non-prescription cough and cold products. It’s been truly fascinating to interact with parents and their children in diverse community settings and to learn how the audience and context impact our message and its delivery. So far we’ve done 20 talks to 185 parents of over 200 children under 6 years of age. What’s amazing is that only 24 (13%) parents were aware of the important message that: over the counter cough & cold products are not safe. Those who were aware learned through the media (7), doctor’s office (6), day-care (1)  pharmacist (5), relatives who are health professionals (4), community centre (1)

Some of the places we have been to include:

  • Community drop-in programs where parent groups drop in to learn about community resources. Some of these have been excellent because they offer child-minding thus allowing parents to focus on the presentation. Mobile child minding has been extremely valuable in these venues. In some of the programs, the children are in the same room but on the side. Some parents even bring a grand-parent to mind the children so that they can focus on the talk.
  • Diverse language programs: it was a really rewarding experience to present to three Chinese speaking groups. The translation factor may be challenging but overall, it was clear that they understood and valued the message. We verified that there is a Chinese word that distinguishes viruses from bacteria – which was excellent. It was particularly helpful to learn about the medication practices in the Chinese community and the need to promote safety through culturally sensitive workshops.
  • Preschool oriented programs aimed at children: these have been a really effective way to connect with the parents. It is quite possible that the parents who are aware of this programs and motivated to bring their children may not be typical parents. They have proven knowledgeable and engaged in learning about their children’s health. This makes us wonder about the characteristics of parents that we are not reaching through these venues.
  • Community health centres: these are groups facilitated by a nurse. These have been excellent because the facilitator is a health professional who can prompt us to address the questions that matter to the parents. For example, one nurse asked us to come back and address the topic of drugs and breastfeeding – an excellent topic for her group.
  • Libraries: These have been really interesting because they are key centres of learning in the community. One approach has been to visit story-telling programs that libraries organize for families. The story-time is based on a health theme after which we talk to the parents. The challenge here of course is to engage both the young ones, who are the central audience and the parents. Children’s librarians can help us with creative ideas to keep the little one’s interested in our message as well. The other approach has been to organize a standalone program aimed at parents of young children. Where well promoted in advance, this has been very successful as parents come eager to listen to the message and able to stay for the entire length of the presentation. Less successful has been the attempt to offer our presentation in the place of a story program. Since not all parents attend all the sessions, they were not aware that we were offering a different presentation from their regular program.

Reflections:

  • Given the alarmingly small proportion of parents who are aware of this message, it is clear that a multi-pronged strategy is required to reach parents with this important information. The message needs to be available in languages other than English and French (Canada’s official languages).
  • To simplify things, we emphasized the message: most colds are caused by viruses and there is therefore no cure; over the counter cough & cold medications are not safe and it is safe to give plain pain-killers only (not combination products) to manage fever. However, parents wanted to know the reason why these products were no longer safe for children under 6. Particularly concerned, were those who had older children and had used these products before. It was important to explain that these drugs were released back in the 60s and 70s and since then, there had been no evidence to support their effectiveness. At the same time, there was clear data to show that children metabolized these drugs differently from adults and there were reports of serious side effects not only in Canada but in Europe, US and elsewhere. This reinforces the value of understanding how adults learn and supporting that when conveying messages.
  • The discussion of non-medicinal remedies was essential for supporting actionable behavioural change. It would have been unrealistic to expect parents to follow this recommendation without a clear alternative for handling cough and cold symptoms. Encouraging parents to share their own experiences of successful remedies was empowering and effective. Many of them were knowledgeable and played the role of peer educators.
  • The parents posed thought-provoking questions some of which were based on their cultural background and traditional practices. Others sought clarification while some stemmed from common beliefs and conceptions that need to be validated by evidence. For example, how do I tell the difference between a bacterial and viral infection? Are there safe homeopathic remedies? Are these effective? Does applying alcohol on the child’s body bring down fever? Does massage therapy help with cold symptoms? Is it okay to cut an adult’s Tylenol pill into half for a child? My child is x pounds. How much of drug y should I give him? Are antihistamines okay for allergies? Why call it baby aspirin and yet it’s not safe for kids under 20?
  • Our Fortune Teller was very popular as it was a lot of fun: everyone enjoys folding it and we can’t keep up with the demand.
  • The most valuable information we can give consumers is how to find health reliable information – such sources as BC health guide.
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Preschool parents learn about managing colds

October 22, 2009

The BC Strong Start program is a free program that provides early learning activities for preschool children. As the parents are required to accompany their children, this was an excellent forum for us to educate parents about Health Canada’s advisory against over-the-counter cough and cold products for children and how best to manage the symptoms. The Strong Start program at Parkside Elementary School is run by a dedicated facilitator who occupied the little ones as we spoke to their parents. An informal talk rather than do a formal Powerpoint presentation , it worked better for this group.  Of the eight participants, three were aware of Health Canada’s advisory – which was better than most groups we have talked to so far. One got this message from a pharmacist which underscores the important role of community pharmacists in promoting drug safety.

The parents were very knowledgeable and asked a lot of questions which generated good conversation:

  • The doctor said that cough and cold medication is safe if properly used. Is this true? Answer: No. While true that these medications are often associated with misuse and overdose, they are no longer considered safe. There is no evidence that they work and they could cause serious harm.
  • Why have these medications suddenly become unsafe? Most of these products are early generation drugs that were mainly tested in adults. There is clear evidence that children do not metabolize medication in the same way as adults and this is why many countries have decided to bar their use in children.
  • Are safer products for children going to be developed? Answer: Only manufacturers can answer those questions
  • Are antihistamines for allergies safe? The advisory applies to the use of antihistamines being used for coughs and colds – not allergies.
  • What is safe for fever? Answer: acetaminophen (Tylenol) is the safest to use for fever and pain as it has been around for the longest. It is really important to use plain Tylenol – not for colds. Ibuprofen (Advil, Motrin) is good if there is also inflammation in addition to fever and pain but is harder on the stomach and should not be used in children under 6 months. ASA (Aspirin) should not be used in children under 20 years old as it could cause Reye’s syndrome. 
  • One parent said that her friend always gave her child slightly more than the recommended dose because she thought that it would not be strong enough to be effective. All parents agreed that this was very unsafe indeed. Always go by the recommended dose, using the right measuring device. Good medication information is found in the BC Health Guide
  • Good non-medicinal methods suggested included: elevating with pillows, honey (available in honey sticks), vapour/steam, Vicks for children. One parent said that the humidifier did not work for her child.

Engaging young parents at community health centre

October 22, 2009

Talking to parents at a community health centre about Health Canada’s advisory and over-the-counter cough and cold medicines was a very rewarding experience. This is a program run by a public health nurse and aimed at parents of children under 1 year old. All except one were first time parents. We talked to 2 groups:

  1.  14 English speaking participants (one dad accompanied the baby’s mother) 
  2. 4 Chinese speaking mothers

As the babies were so young, it was possible to do the full powerpoint presentation with minimal disruption. We first went around the room and asked them to introduce themselves, their little one and what they did when they had coughs and colds. This worked very well. Unlike other groups, this one is facilitated by a health professional and their knowledge level reflected this. Three had heard about the advisory from the news. They were aware of non-drug techniques for managing cold and cough symptoms – saline solution and humidifiers. The nurse added that saline solution can safely be used in babies from birth – it makes them sneeze but that is good for them.

Questions included:

  • Why should the humidifier be cool and yet hot vapour is good for colds? Answer: Heat may encourage the growth of  bacteria unless thoroughly cleaned so humidifiers that run continuously are best kept cold. Vaporizers and steamers can be used for short periods and turned off.
  • Nurse asked what medications are safe for breastfeeding mothers. Answer: Always ask the pharmacist
  • Are throat lozenges okay? Answer: Depends on whether they have a medicinal ingredient. If just zinc or lemon, they are okay.
  • Why is Advil not appropriate for kids under 6 months? Answer: they are too young to metabolize it safely

The nurse convening the Chinese group made a really insightful comment about the value of medication safety presentations for the Chinese community. For many of them it is acceptable to mix up different medications in the same container. There are many communities that may have peculiar medication practices and cultural sensitivity will help us promote safe drug use.

Delta parenting group shares cold management tips

October 9, 2009

A session with a Delta parenting group on our pediatric cough and cold management topic went very well. In this group, none of the parents were aware of the Health Canada advisory. In attendance, were 14 parents with eight children under 6 years of age.

A wonderful provision was child minding in a nearby room. The organizers are able to arrange child-minding on-site so that the parents can focus on their learning undistracted.  As a result, we were able to go over the entire Powerpoint presentation and the lively group had the opportunity to non-medicinal cold management techniques:

  • Use of a humidifier
  • Saline drops
  • vapor
  • Placing hot towel on child’s chest

The parents’ asked a lot of good question including:

  • How do you distinguish a viral from a bacterial infection? Answer: a viral infection results in clear secretions while a bacterial infection will produce green/yellow mucous/sputum
  • What were the serious side-effects reported in the use of over the counter cough and cold medications in children under six? Answer: loss of consciousness, seizures, death in some cases
  • As some of these adverse effects were associated with over-doses, is it okay to use over the counter cough and cold medications, so long as you are careful with dosing? Answer: No. The risks outweigh the benefits – and this is why the manufacturers have been asked to relabel them (to indicate that they are not to be used in children below 6)
  • What do you do when child is unable to sleep because throat hurts from coughing? Answer: Try a pain reliever
  • Are health food store/natural products okay for children? Answer: there is a perception that all these natural products are harmless but always consult a doctor
  • What’s the different between a humidifier and a vaporiser? A vaporizer produces steam – caution required. A humidifier produces cold moisture.

Directing parents to reliable sources of information for answers to their questions is highly valuable. From this group, it was clear that in addition to the information we presented, the parents were able to learn from one another as well. One parent said that the doctor had advised using steam to help clear her child’s congestion but she wondered how to safely do this. Another parent explained that running hot water in the bath would quickly fill the room with steam which the child could safely inhale.

Kids learn about cough and colds at Aldergrove library story time

October 9, 2009

This week, we had a wonderful time presenting our message to parents and preschoolers at the Aldergrove branch of the Fraser Valley library system. The session was attended by four parents and their six little ones.  Beebee, the children’s librarian begun by reading from these fun stories to the children:

  • Buster catches a cold
  • Dear Daisy get well soon
  • Farm Flu

It was so delightful to watch the spell-bound children as they listened to the fascinating story of why the rooster couldn’t coock-a-doodle because he had a sore throat. The remedies recommended for the rooster included tea with honey as well as rest – perfect non-medicinal ways to manage symptoms! After the story time, we spoke to the parents.  Since the story time theme already referenced our message, it was easy to transition into our talk and still keep the little ones engaged.  We focused on our colorful fortune-teller handout. It was good to see that they knew the key message to “wash their hands.”

None of these parents had encountered the Health Canada advisory so it’s clear that we need to continue disseminating this important message at every opportunity. From this session it was clear that

  • having a brief story time for the children prior to the talk for the parents worked better than dedicating the entire story time session to the presentation.
  • we needed to be flexible in doing an informal talk when kids were present rather than a formal Powerpoint presentation

Language not a barrier at Chinese family drop-in group

October 1, 2009

We had the privilege of talking to a Chinese family drop-in group held at a Richmond community centre about the over the counter cough and cold medication advisory. The facilitator had said that she never knows how many will show up but  14 families came!  The facilitator had two volunteers to help occupy the children in a corner of the room. Some of the parents brought the grand parents to look after the children while they listened to the program. Yes, it was noisy but necessary because the children are calmer if they see their parents across the room.

Of the 14 parents, 1 had seen the advisory leaflet at another drop-in program while the rest were unaware of the message. We went over the Powerpoint presentation, relying on the translator to translate every few sentences. We wondered how effective the delivery was but  it turned out that the parents understood the message very well. We could tell this from their insightful comments and questions:

  • The translator was unsure of the Chinese word for humidifier (it was amusing to see the parents help her out).
  • One parent said that they applied alcohol on their child’s body to cool down a fever. Evaporation of alcohol would have a cooling effect but this was the first time we were hearing of this. We need to look into this.
  • What do you do with the saline solution (salt water) – give the child to drink? No, it’s administered as nose drops to help with a stuffy nose. We needed to be more explicit.
  • What’s the recipe for the salt water? It is commercially available but can be prepared at home. We’ll find a recipe and share it with parents

One of the points that all the parents appreciated learning was the need to a) use proper measuring devices for medication rather than kitchen spoons and b) take the child’s weight into account when determining dosage

The facilitator had prepared a number of resources and handouts to support our message – emphasizing the importance of correct hand-washing in cold prevention.  We talked about the value of the BC health Guide as a source of health information for these parents. These community groups and the dedicated facilitators who run them have a really important role in disseminating health information and promoting health particularly in diverse communities. And who said that language is a barrier?

Inspiring cough and cold session at Aboriginal centre

September 25, 2009

For the next little while, my pharmacist colleague and I are visiting community groups and giving a talk on how to safely manage coughs and colds in children under 6. In December 2008, Health Canada issued the directive that manufacturers of OTC (over the counter) cough and cold medications should relabel them to state they should not be given to children under 6 years of age. We are giving talks to parents of young children to ensure that they understand the message and more importantly, how to safely manage cough and cold symptoms in their children. The essence of the talk is:

  • there is no cure for the common cold as it is caused by a virus
  • hand-washing is the best way to prevent a cold
  • many over-the-counter cough and cold medicines are no longer recommended for kids under 6 years of age
  • it is okay to treat fever and pain
  • use non-medicinal ways to help with symptoms

Our first session was at an Aboriginal Centre program, Surrey. We talked to an audience of 6 attentive parents and were thoroughly impressed by their insightful questions which even went beyond the scope of the topic. My pharmacist colleague was able to answer their questions and it was eye opening for them to learn that they can ask their pharmacists for information and clarification. We encouraged them to share the ways they used to alleviate the symptoms in their children. One of the questions however threw us off because they wanted advice on whether they should get flu shots or not – and they insisted on us telling them what our personal choice was. From this it was clear that they would benefit from knowing where to get accurate health information in order to assess their risks and make informed decisions.