Health literacy and accessible paediatric information — formative SAQs

SAQ 1 — Liquid-medication dosing and discharge safety (10 marks)

A 14-month-old is discharged from the emergency department with a 7-day course of a liquid antibiotic and paracetamol. The prescription is written in teaspoons. The parent speaks limited English and nods when asked "do you understand?" ^{[2] [8]}

Questions

1. Explain why this discharge is at high risk of a medication error, drawing on the evidence for units and dosing tools. (4 marks) ^[2]
2. Describe the discharge communication you would run before the family leaves, naming the specific technique you would use to confirm understanding. (4 marks) ^{[5] [8]}
3. How would you address the language need, and why is the chosen method safer than the alternatives? (2 marks) ^[12]

Model answer

Risk and evidence (4). Prescribing in teaspoons is a direct risk because the household teaspoon varies in volume and causes both overdose and underdose. A randomised study showed that pictograms combined with millilitre dosing tools reduced parent medication errors, and a label-unit experiment showed parents choose safer dosing tools when the unit is mL. Parents also commonly overestimate their comprehension of discharge instructions, especially when the plan is complex, so a nod is no reassurance. ^{[2] [3] [8]}

Discharge communication (4). Represcribe the dose in millilitres, dispense a marked oral syringe, and add a pictogram. Explain the plan in plain language, one idea at a time. Then run teach-back: ask the parent to explain in their own words how much medicine to give, how often, for how many days, and what would bring them back. Re-explain any gap without blame and confirm before they leave. A written, low-reading-level summary and a safety-net complete the handover. ^{[5] [8]}

Language need (2). Use a professional interpreter in person, by phone or by video, and record the language and dialect so the need follows the child. This is safer than using a relative or child as interpreter, which risks unsafe miscommunication and breaches confidentiality; parents less comfortable in English experience more adverse events when their child is hospitalised. ^[12]