Prescribing safely for children

Supratherapeutic utilization of paracetamol versus ibuprofen among <12-year-old children in primary care in Istanbul

BACKGROUND

Paracetamol and ibuprofen are the most preferred analgesics for pain and fever management in children. Prescribing of these drugs in supratherapeutic doses may predispose to their toxicity. We aimed to compare prescribing patterns and potential overdosing of paracetamol and ibuprofen in primary care for <12-year-old children.

METHODS

We analysed paracetamol- and ibuprofen-containing prescriptions (PCPs, n = 173,575 and ICPs, n = 145,655) of 1- to 11-year-old children, issued by 3:1 systematically sampled primary care physicians (n = 1,431) in Istanbul during 2016. We compared drug use parameters and prescriptions surpassing daily and single-use dose limits for paracetamol and ibuprofen.

RESULTS

We identified that 29.9% of PCPs and 20.8% of ICPs were generated for those aged 1-2 years. Concomitant analgesic use was higher in ICPs than in PCPs (15.1% vs. 12.8%). We found that 4.4% of PCPs and 3.1% of ICPs exceeded maximum daily dose limit of paracetamol and ibuprofen, respectively (P < 0.001). This was more common in girls (5.1% and 3.3%, respectively) and at 1 year of age in both groups (9.2% and 8.5%, respectively). Single-use supratherapeutic dosing was encountered in 16.5% of PCPs and 13.2% of ICPs (P < 0.001, pessimistic model) and in 8.6% of PCPs and 10.6% of ICPs (P < 0.001, optimistic model).

CONCLUSIONS

Paracetamol and ibuprofen were generally used in primary care for similar clinical conditions with subtle differences. However, more pronounced in younger children and girls, potential overdosing seems to be more practiced for paracetamol than ibuprofen both in terms of maximal daily and single-use setting.

Cross-sectional study identifying high-alert substances in medication error reporting among Swedish paediatric inpatients

AIM

The aims were to characterise paediatric medication errors and to identify the prevalence of known high-alert substances in these errors.

METHODS

All paediatric drug-related incident reports and complaints nationally reported to the Health and Social Care Inspectorate in Sweden 2011-2017 regarding inpatients were characterised by context and modal details. In addition, drug use at a university hospital was matched to local incident reports. Drug substances were classified using three high-alert lists.

RESULTS

On a national level, there were 160 reports (2.5 per 10 000 patients) in which the three high-alert lists were found in different degrees (17/35/47%). Morphine (n = 12), vancomycin (n = 11) and potassium (n = 7) were most frequently involved. Eighty per cent of the reports concerned patients aged 0-6 years. Intravenous was the most common route of administration (66%). On a university hospital level, the prevalence of all types of drug incidents reports was 1.7% among all inpatients. The prevalence of local incident reports involving high-alert substances was almost double that of non-alert substances.

CONCLUSION

Existing high-alert drug lists are relevant for paediatric inpatients. A higher awareness and usage of such lists among hospital staff prescribing, dispensing and administering drugs to children may have the potential to reduce medication errors.

An exploration of pediatric nurses' compliance with a medication checking and administration protocol

PURPOSE

This study examined nurses' reported compliance with the medication administration protocol and explored reasons for noncompliance.

DESIGN AND METHOD

A mixed-methods design incorporated a questionnaire (n= 72) and focus groups (n= 24).

RESULTS

Differences were found between the level of experience and protocol compliance. Noncompliance was widespread in the checking of identification bands and double-checking medications. Key factors influencing compliance were ward culture, type of drug, familiarity with patient and drug, and workload. The reported realities of practice were found to influence compliance with the medication administration protocol.

PRACTICE IMPLICATIONS

The discrepancies between protocol and practice in this setting underscore the need to more widely investigate compliance with medication administration protocols in other settings.