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[Drug administration to paediatric inpatient]
1Pharmacie et laboratoire de toxicopharmacologie, hôpital Robert-Debré, Assistance-publique-Hôpitaux de Paris, France. jean-eudes.fontan@jvr.ap-hop-paris.fr <jean-eudes.fontan@jvr.ap-hop-paris.fr>
Insights
Pediatric drug administration in France faces significant challenges, with many available medications unsuitable for children. This study highlights issues with drug suitability and administration practices, proposing solutions for improved pediatric patient care.
Area of Science:
- Pharmacology
- Pediatric Medicine
- Drug Administration
Context:
- Commercial drugs available in France are often not suitable for pediatric inpatients.
- Current drug formulations and administration practices pose challenges for nurses caring for children.
Purpose:
- To identify and quantify difficulties encountered by nurses in administering oral and parenteral medications to pediatric inpatients.
- To propose solutions for the identified problems in pediatric drug administration.
Summary:
- A study involving 1,946 observations in 14 hospitals revealed significant issues with pediatric drug administration.
- Problems included incorrect drug dilutions, inappropriate formulations (e.g., injectable drugs for oral use), incorrect dosages, waste, and off-label use of medications.
- Specific challenges were noted for injectable drugs, liquid oral forms, capsules, tablets, and bagged medications.
Impact:
- Confirms the unsuitability of many commercial drugs for pediatric inpatients.
- Underscores the need for evidence-based recommendations and improved practices in pediatric drug administration.
- Provides a basis for developing corrective actions to enhance medication safety and efficacy in children.
Objective:
Available commercial drugs in France are often unsuitable for children. The aim of this study was, for every medicinal form orally or parenterally administered, to identify and to quantify difficulties met by the nurses administering drugs to paediatric inpatients and to propose solutions to main identified problems.
Material And Method:
The study was realized in 14 hospitals by direct observation. The observer, provided with a questionnaire, followed during a time slot of at least 2 h for one or several nurses and raised all the oral or injectable administrations.
Results:
One thousand and nine hundred forty-six observations were performed. The children were 12.6 +/- 17 months old, and weighed 8.5 +/- 9.4 kg. Injectable drugs: half of the observations showed a posology and a mode of dilution not corresponding to the summary of product characteristics. Eight percent of orally administered drugs were injectable drugs. In 35.5% of cases, administered amount was lower than the quarter of the present quantity in the therapeutic unity. The rest of the therapeutic unity was thrown (77.2% of cases). Liquid oral forms: liquid oral forms were ready for use regarding 83.8% of cases. The medicine was readministered to the same patient (23.5%), and/or administered to other patients (80.0%). Capsules: 66.9% of the administered capsules were prepared by the hospital pharmacies. The pharmacies organized with an unit dose drug dispensing system produced significantly more preparations than those working by global distribution (P < 0.0001). In 58.4% of cases, the administered capsule was an off-label drug. Tablets: 46% of drug administration concerned a tablet without pediatric indication. 46.7% of tablets were cut, 74% were crushed. Bags: in 35.2% of observations, the bag was not administered in its entirety.
Conclusion:
Our study confirms the unsuitability of drugs to paediatric inpatients, the necessity of recommendations of good practices in the administration of drugs to paediatric inpatients, and proposes corrective actions.
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