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Oral dosage form administration practice in children under 6 years of age: A survey study of paediatric nurses
A C Walch1, E Henin2, J Berthiller1
1Clinical Investigation Centre CIC-INSERM 1407, EPICIME, Department of Clinical Pharmacology, Hospices Civils de Lyon, France.
Insights
Paediatric nurses report challenges administering solid medications to young children, with refusal being a primary issue. Many nurses crush or split tablets, highlighting a need for better administration tools for pediatric patients.
Area of Science:
- Pediatric Pharmacology
- Nursing Practice
- Drug Administration
Background:
- Administering solid oral dosage forms to young children presents unique challenges.
- Understanding paediatric nurses' perspectives on medication administration is crucial for improving patient adherence and outcomes.
Purpose of the Study:
- To investigate paediatric nurses' experiences and challenges with administering extemporaneous and marketed capsules and tablets to children under six years old.
- To identify factors influencing the successful administration of solid oral medications in paediatric patients.
Main Methods:
- A survey was conducted with 59 paediatric nurses across six hospital wards.
- Nurses were interviewed regarding their practices and perceptions of administering solid medications to children under six.
- Data collected included estimated age for swallowing solids, reasons for administration failure, and medication manipulation techniques.
Main Results:
- Nurses estimated children could swallow extemporaneous capsules around 7.7 years and marketed solids around 7.3 years.
- A significant percentage of nurses (33-37%) believed children under six would not receive prescribed treatment with solid forms.
- Child refusal was the leading cause of administration failure (85-89%), followed by formulation type and chewing requirements.
- Most nurses crush tablets for non-swallowing children, and 37% split tablets for those able to swallow.
- Limited availability and use of information tools for manipulating solid medications were reported.
Conclusions:
- Paediatric nurses face significant challenges in administering solid medications to young children, primarily due to refusal and age-related swallowing difficulties.
- Current practices involve medication manipulation (crushing/splitting), indicating a need for age-appropriate formulations and better guidance tools.
- Further research and development of resources are needed to support nurses in optimizing medication administration for paediatric patients.
Abstract:
The purpose of this study was to interview paediatric nurses on administration issues using extemporaneous capsules and marketed capsules and tablets in children younger than 6 years old, based on most frequently administered drugs in six participating wards. The 59 responding nurses estimated respectively at 7.7±1.7 and 7.3±1.8years the age from which children would properly swallow extemporaneous capsules and marketed solids, with 33% and 37% of nurses considering that children under 6 would not get their prescribed treatment using these dosage forms. Refusal of the child to take the solid was the first reason to explain administration failure (85% of nurses for extemporaneous capsules, 89% for marketed solids). Although type of formulation and requirement of chewing were factors influencing the age at which children would take solid from nurses' experience, size of conventional tablets was not among these factors. All respondents use to crush tablets in children unable to swallow whole solids; 37% of nurses systematically split the tablets to ease the swallowing in children able to swallow. Only 11 nurses had an information tool at their disposal to guide manipulation of solids, with 7 of them using it in their daily practice. Providing specific-ward questionnaires, this study gives factual information on administration practices, perceptions and issues faced by paediatric nurses.
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