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Chachlioutaki K, Gioumouxouzis C, Karavasili C, Fatouros DG. Small patients, big challenges: navigating pediatric drug manipulations to prevent medication errors - a comprehensive review. Expert Opin Drug Deliv 2023; 20:1489-1509. [PMID: 37857515 DOI: 10.1080/17425247.2023.2273838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/18/2023] [Indexed: 10/21/2023]
Abstract
INTRODUCTION Medication errors during drug manipulations in pediatric care pose significant challenges to patient safety and optimal medication management. Epidemiological studies have revealed a high prevalenceof medication errors throughout the medication process. Due to the lack of age-appropriate dosage forms, medication manipulation is common in pediatric drug administration. The consequences of these manipulations on drug efficacy and safety could be devastating, highlighting the need for evidence-based guidelines and standardized compounding practices. AREAS COVERED This review focuses on examining medication errors in pediatric care and delving into the manipulation of medicinal products. EXPERT OPINION The observed prevalence of medication errors and manipulations underscores the importance of addressing these issues to enhance patient safety and improve medication outcomes in pediatric care. Overall, the development of age-appropriate formulations and the dissemination of comprehensive clinical guidelines are essential steps toward improving medication safety and minimizing manipulations in pediatric healthcare settings.
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Affiliation(s)
- Konstantina Chachlioutaki
- Department of Pharmacy Division of Pharmaceutical Technology, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Center for Interdisciplinary Research and Innovation (CIRI-AUTH), Thessaloniki, Greece
| | - Christos Gioumouxouzis
- Department of Pharmacy Division of Pharmaceutical Technology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christina Karavasili
- Department of Pharmacy Division of Pharmaceutical Technology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios G Fatouros
- Department of Pharmacy Division of Pharmaceutical Technology, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Center for Interdisciplinary Research and Innovation (CIRI-AUTH), Thessaloniki, Greece
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Daibes MA, Qedan RI, Al-Jabi SW, Koni AA, Zyoud SH. Nurses' knowledge and practice regarding mixing medications with food: a multicenter cross-sectional study from a developing country. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2023; 42:52. [PMID: 37277885 DOI: 10.1186/s41043-023-00396-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 06/01/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Different pharmaceutical characteristics of the dosage form (DF) have a direct effect on how easily oral solid medicine is swallowed. The practice of crushing tablets or opening the capsule occurs daily in the hospital, and most nurses are unknowledgeable regarding these issues. Coadministration of medications with food can cause changes in drug absorption and lead to an alteration in gastrointestinal motility, which can cause an unexpected effect on the dissolution and absorption of the drug. Therefore, this study aimed to investigate nurses' knowledge and practices regarding the mixing of medications with food or drink in Palestine. METHODS From June 2019 to April 2020, a cross-sectional study was conducted, encompassing nurses working in government hospitals across various districts of Palestine. The data were collected through face-to-face interviews, using questionnaires that assessed nurses' understanding and implementation of mixing medications with food. The sampling method employed was convenience sampling. To analyze the gathered information, the Statistical Package for the Social Sciences version 21 (IBM-SPSS) was utilized. RESULTS A total of 200 nurses participated in the study. The data show a significant difference between the median knowledge scores according to the department of work (p < 0.001). The highest median [interquartile] knowledge score of 15 [12-15] was found for nurses working in the neonatal intensive care unit. In addition, nurses in the pediatric ward and the men's medical ward had high scores of 13 [11.5-15] and 13 [11-14], respectively. In general, the results show that 88% of nurses modified oral DF prior to administration to patients. Regarding the type of food used, mixing medicine into juice was the most common procedure performed by nurses (approximately 84%); 35% of nurses used orange juice to mix with medicine. The most common reason for crushing was to administer medications to patients with a nasogastric tube (41.5%). In regard to medications, aspirin was the most frequently used drug that was crushed by the nurses (44%); however, 35.5% of nurses did not feel sufficiently trained to carry out this practice. Concerning the sources of information, 58% of nurses usually asked pharmacists for information about medications. CONCLUSIONS The results of this study show that crushing and mixing medications with food is common among nurses, and most nurses are unaware of the dangerous effect of this practice on patient health. Pharmacists, as medication experts, should participate in sharing knowledge about unnecessary crushing situations or when crushing should be avoided and try to find an alternative, when available, to aid administration.
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Affiliation(s)
- Marah A Daibes
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
| | - Rawan I Qedan
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
| | - Samah W Al-Jabi
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
| | - Amer A Koni
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
- Division of Clinical Pharmacy, Department of Hematology and Oncology, An-Najah National University Hospital, Nablus, 44839, Palestine
| | - Sa'ed H Zyoud
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
- Poison Control and Drug Information Center (PCDIC), Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
- Clinical Research Center, An-Najah National University Hospital, Nablus, 44839, Palestine.
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Accuracy of Dose Administered to Children Using Off-Labelled or Unlicensed Oral Dosage Forms. Pharmaceutics 2021; 13:pharmaceutics13071014. [PMID: 34371705 PMCID: PMC8308974 DOI: 10.3390/pharmaceutics13071014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 12/05/2022] Open
Abstract
The pediatric population suffers from a lack of age-appropriate medicines leading to unsafe situations when off-labelled or unlicensed drugs are used. Assessing the best option to administrate medicines when manipulations are required is essential in order to improve child care. This study aimed to compare the accuracy of the administered dose provided by three dosage forms and their techniques of administration. Different techniques of administration were assessed, covering three oral dosage forms (commercially available tablets, capsules, oral suspensions) using two APIs not available in a children-adapted dosage form. Techniques of administration were simulated and administered doses were determined using HPLC-UV. Means were compared to the target dose while distributions of doses were compared between each technique. For both APIs, mean administered doses obtained with capsules and tablets were significantly different from the target dose, whereas there was no statistical difference with oral suspensions. Distributions of doses showed significant difference between the three dosage forms. This study demonstrates that manipulations of solid oral dosage forms provide dramatic underdosing leading to unsafe situations. Compounded oral suspension is the best option to avoid underdosing and dose variation. This solution should be prioritized when age-appropriate commercial medicines are not available.
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Ejeta F, Gabriel T, Joseph NM, Belete A. Formulation, Optimization and In Vitro Evaluation of Fast Disintegrating Tablets of Salbutamol Sulphate using a Combination of Superdisintegrant and Subliming Agent. Curr Drug Deliv 2021; 19:129-141. [PMID: 34126894 DOI: 10.2174/1567201818666210614094646] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 02/23/2021] [Accepted: 04/07/2021] [Indexed: 11/22/2022]
Abstract
AIM The present research work was aimed to formulate fast disintegrating tablets (FDTs) of salbutamol sulphate (SBS) using a combination of superdisintegrant and subliming agent, optimize the formulation and evaluate the in vitro performance of the developed FDTs. MATERIALS AND METHODS A formulation of SBS FDT was developed using a combination of superdisintegrant - crospovidone and subliming agent - ammonium bicarbonate (AB) in which formulation variables, namely levels of crospovidone and microcrystalline cellulose (MCC):Mannitol (MNTL) ratio were evaluated for their effects on the response variables - disintegration time, hardness, friability and wetting time of the resulting FDTs. By employing a central composite design (CCD) methodology, the FDTs were optimized to achieve optimum levels of the formulation factors. RESULTS The desired optimum condition was obtained at 7.82% crospovidone and 70% of 1.56:1 MCC: MNTL ratio while maintaining AB at 5% level for aesthetic reasons. Under the optimized conditions, the disintegration time, hardness, friability and wetting time were 14.57±0.53 sec, 7.17±0.82 kg/cm2, 0.311% and 13.14±0.69 sec, respectively. The experimentally observed responses were found to be in close agreement with the predicted values for the optimized formulation. Moreover, the validity of the obtained optimal point was confirmed by the low magnitude of percent prediction error (<5%). CONCLUSION FDTs of SBS were successfully formulated and optimized using CCD employing a combination of superdisintegrant and subliming agents.
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Affiliation(s)
- Fikadu Ejeta
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tesfaye Gabriel
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Nisha Mary Joseph
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Anteneh Belete
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Assessment of practices for suspended oral drugs by tablet crushing in pediatric units. Eur J Pharm Biopharm 2020; 157:175-182. [DOI: 10.1016/j.ejpb.2020.10.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 10/16/2020] [Accepted: 10/20/2020] [Indexed: 11/20/2022]
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Soares Rodrigues Costa B, Pontes do Nascimento L, Vítor de Paiva Amorim M, Barreto Gomes AP, Mafra Veríssimo L. Stability of extemporaneous sulfadiazine oral suspensions from commercially available tablets for treatment of congenital toxoplasmosis. Trop Med Int Health 2019; 25:364-372. [PMID: 31802579 DOI: 10.1111/tmi.13354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine the physicochemical and microbiological stability of sulfadiazine suspensions (100 mg/mL) in simple syrup (A) and sorbitol (B) formulations prepared from commercially available tablets. METHODS An ultra-performance liquid chromatographic assay was developed and validated to determine the chemical stability of sulfadiazine. Three samples were prepared and stored at 5 and 25 °C and assayed at 0, 7, 14 and 30 days. Physical parameters (appearance, pH, particle size and viscosity) were also monitored. Microbiological examination was performed through the suitable counting method. RESULTS The formulations presented a sulfadiazine concentration of around 95% at the beginning at both temperatures. There was some variation in pH, viscosity and particle size distribution over time. The samples met the pharmacopoeia criteria of microbiological quality over 30 days, but only sulfadiazine formulated in syrup stored at 25 °C was suitable for use after one week. CONCLUSION The sulfadiazine suspension in simple syrup was chosen as the most suitable formulation because it demonstrated stability for 14 days at room temperature, providing an alternative liquid dosage form of sulfadiazine for congenital toxoplasmosis treatment.
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Affiliation(s)
- Brunna Soares Rodrigues Costa
- Programa de Pós-Graduação em Ciências Farmacêuticas, Universidade Federal do Rio Grande do Norte, Natal, Brasil.,Núcleo de Pesquisa em Alimentos e Medicamentos, Universidade Federal do Rio Grande do Norte, Natal, Brasil
| | | | | | - Ana Paula Barreto Gomes
- Programa de Pós-Graduação em Ciências Farmacêuticas, Universidade Federal do Rio Grande do Norte, Natal, Brasil.,Departamento de Farmácia, Universidade Federal do Rio Grande do Norte, Natal, Brasil
| | - Lourena Mafra Veríssimo
- Núcleo de Pesquisa em Alimentos e Medicamentos, Universidade Federal do Rio Grande do Norte, Natal, Brasil.,Departamento de Farmácia, Universidade Federal do Rio Grande do Norte, Natal, Brasil
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van der Vossen AC, Al-Hassany L, Buljac S, Brugma JD, Vulto AG, Hanff LM. Manipulation of oral medication for children by parents and nurses occurs frequently and is often not supported by instructions. Acta Paediatr 2019; 108:1475-1481. [PMID: 30632630 DOI: 10.1111/apa.14718] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 12/25/2018] [Accepted: 01/08/2019] [Indexed: 11/27/2022]
Abstract
AIM Due to a lack of age-appropriate formulations, administration of drugs to children remains a challenge. This study aimed to identify the problems experienced in both the outpatient setting and the clinical setting. METHODS Between June 2017 and January 2018, we performed a cross-sectional, prospective study at the Sophia Children's Hospital, The Netherlands. The study comprised of a structured interview on drug manipulations with parents visiting the outpatient clinic, and an observational study of drug manipulations by nurses at the wards. RESULTS A total of 201 questionnaires were collected, accounting for 571 drugs and 169 manipulations (30%). Drug substances that were most often mentioned as manipulated were macrogol (n = 23), esomeprazole (n = 15), paracetamol (n = 8), methylphenidate (n = 7) and melatonin (n = 7). Of all manipulated medicines, 93/169 (55%) were manipulated according to the instructions or recommendations of the Summary of Product Characteristics (SmPC) or patient information leaflet. During the observational study, manipulation was performed by 21/35 of observed nurses (60%), of whom 11 deviated from the hospital protocol for manipulation or SmPC (52%). CONCLUSION Manipulation was a widely used method to administer drugs to children. Validated information regarding manipulation of drugs for both parents and nursing staff is needed.
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Affiliation(s)
- Anna C. van der Vossen
- Department of Hospital Pharmacy; Erasmus MC; University Medical Center Rotterdam; Rotterdam The Netherlands
| | - Linda Al-Hassany
- Department of Hospital Pharmacy; Erasmus MC; University Medical Center Rotterdam; Rotterdam The Netherlands
| | - Sandra Buljac
- Department of Hospital Pharmacy; Erasmus MC; University Medical Center Rotterdam; Rotterdam The Netherlands
| | - Jan-Dietert Brugma
- Department of Outpatient Pharmacy; Erasmus MC; University Medical Center Rotterdam; Rotterdam The Netherlands
| | - Arnold G. Vulto
- Department of Hospital Pharmacy; Erasmus MC; University Medical Center Rotterdam; Rotterdam The Netherlands
| | - Lidwien M. Hanff
- Department of Hospital Pharmacy; Erasmus MC; University Medical Center Rotterdam; Rotterdam The Netherlands
- Department of Hospital Pharmacy; Princess Maxima Center for Pediatric Oncology; Utrecht The Netherlands
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Saito J, Akabane M, Komura M, Nakamura H, Ishikawa Y. Age-Appropriate Pediatric Dosage Forms in Japan: Insights into End-User Perceptions From an Observational Cross-Sectional Survey Assessing the Acceptability of Oral Formulation. Ther Innov Regul Sci 2018; 53:455-471. [PMID: 30157669 DOI: 10.1177/2168479018791133] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The lack of appropriate pediatric formulations is a global issue and information on acceptability is urgently needed to develop standard pediatric formulations. This study aimed to assess perceptions of acceptability of several oral dosage forms among pediatric patients at a community and a pediatric hospital in Japan and collected information about age-appropriate pediatric formulations, aiming to contribute to drug development promotion worldwide. METHODS A cross-sectional observational study was performed. A convenience sample of caregivers was recruited from available chain-owned retail pharmacies and inpatient pediatric units. The questionnaire was composed of 3 parts: (1) acceptability of the 5 dosage forms (tablets, capsules, powders, liquids, and orally disintegrating tablet) by age; (2) acceptability of dosage size, amount, and volume by age; and (3) the actual method of administration. Face-to-face interviews were conducted at 3 independent community pharmacies (324 parents) and tertiary care pediatric hospital wards (112 nursing staff). Acceptability scores and acceptable dosages were then determined. The survey was conducted from October 1 to December 1, 2017, for the hospital setting and November 1 to 30, 2017, for the outpatient setting. RESULTS The acceptability of oral dosage forms was roughly similar to the matrix drafted by the European Medical Agency. Differences in perception of the powder forms between communities and hospitals were also observed, with the nursing staff perceiving powder as being acceptable from the neonatal period. CONCLUSIONS The difference in caregivers' perception of the acceptability of oral formulations between Japan and Europe was small. The powder form was found to be more acceptable in Japan. Further intervention studies are needed to assess the preferred pediatric formulation worldwide.
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Affiliation(s)
- Jumpei Saito
- 1 Pharmaceutical Department, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan.,2 Department of Clinical Research, Division of Clinical Pharmacology and Oral Formulation Development, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
| | - Miki Akabane
- 1 Pharmaceutical Department, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan.,2 Department of Clinical Research, Division of Clinical Pharmacology and Oral Formulation Development, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
| | - Makoto Komura
- 1 Pharmaceutical Department, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
| | - Hidefumi Nakamura
- 3 Department of Development Strategy, Division for Clinical Trials, Center for Social and Clinical Research, National Research Institute for Child Health and Development, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
| | - Yoichi Ishikawa
- 1 Pharmaceutical Department, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan.,2 Department of Clinical Research, Division of Clinical Pharmacology and Oral Formulation Development, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
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Lajoinie A, Janiaud P, Henin E, Gleize JC, Berlion C, Nguyen KA, Nony P, Gueyffier F, Maucort-Boulch D, Kassaï Koupaï B. Assessing the effects of solid versus liquid dosage forms of oral medications on adherence and acceptability in children. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2017. [DOI: 10.1002/14651858.cd012783] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Audrey Lajoinie
- Clinical Investigation Centre CIC-INSERM 1407, EPICIME, Department of Pharmacotoxicology / Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Evolutive UMR5558; Hospices Civils de Lyon/University of Lyon 1; Lyon France
| | - Perrine Janiaud
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research; University Hospital Basel, University of Basel; Basel Switzerland
| | - Emilie Henin
- Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Evolutive UMR5558; University of Lyon 1; Lyon France
| | - Jean-Cédric Gleize
- Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Evolutive UMR5558; University of Lyon 1; Lyon France
| | - Clémentine Berlion
- Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Evolutive UMR5558; University of Lyon 1; Lyon France
| | - Kim An Nguyen
- Clinical Investigation Centre CIC-INSERM 1407, EPICIME, Department of Pharmacotoxicology / Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Evolutive UMR5558; Hospices Civils de Lyon/University of Lyon 1; Lyon France
| | | | - Francois Gueyffier
- UMR5558, CNRS et Université Claude Bernard - Service de Pharmacologie & Toxicologie; Hopital Cardio-Vasculaire et Pneumologique Louis Pradel; Lyon France
| | - Delphine Maucort-Boulch
- Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Evolutive UMR5558; University of Lyon 1; Lyon France
| | - Behrouz Kassaï Koupaï
- Clinical Investigation Centre CIC-INSERM 1407, EPICIME, Department of Pharmacotoxicology / Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Evolutive UMR5558; Hospices Civils de Lyon/University of Lyon 1; Lyon France
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