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Specialist Pediatric Palliative Care Prescribing Practices: A Large 5-year Retrospective Audit
Anuja Damani1, Naveen Salins1, Arunangshu Ghoshal1
1Department of Palliative Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India.
Insights
This audit of pediatric palliative care prescribing in India found significant noncompliance with WHO guidelines and poor use of generic names. Enhanced prescriber and patient education is crucial for effective symptom management in children with cancer.
Area of Science:
- Oncology
- Palliative Care
- Pharmacology
Background:
- Childhood cancer incidence is rising in India, highlighting the need for specialized pediatric palliative care.
- Effective symptom management in pediatric cancer patients relies on precise knowledge of palliative care formularies, dosing, and guidelines.
- This study retrospectively audited prescribing practices within a tertiary cancer center's specialist pediatric palliative care service.
Purpose of the Study:
- To evaluate prescribing practices for pain and symptom control in children with advanced cancer receiving specialist palliative care.
- To identify areas of noncompliance with established prescribing guidelines.
- To assess the documentation of adverse drug events and patient compliance.
Main Methods:
- A retrospective audit of 1135 medication records from children in specialist pediatric palliative care services.
- Data collected over a 5-year period (2010-2014).
- Analysis focused on drug types, quantities, adherence to guidelines, and documentation.
Main Results:
- 51 drug types were prescribed, averaging 4.2 per prescription. Paracetamol (66.9%) and morphine (33.9%) were common. Ibuprofen was the most frequent NSAID (23.9%).
- Over 50% of prescriptions included aperients, commonly a liquid paraffin and sodium-picosulfate combination. Dexamethasone was used in 51.9% of patients, often with oral chemotherapy.
- Only 33% of prescriptions used generic names, and adverse effects were documented in just 9%. Noncompliance with WHO guidelines occurred in 25% of cases, with patient compliance at 40%.
Conclusions:
- Knowledge of pediatric palliative care formulary, rational drug use, and dosing guidelines is vital for symptom control in children with life-limiting illnesses.
- Poor prescribing practices, including noncompliance with WHO guidelines (25%) and infrequent use of generic names (33%), necessitate prescriber education.
- Alarming patient noncompliance (nearly 66%) underscores the need for intensive patient, family, and caregiver education and empowerment.
Introduction:
There is a gradual increasing trend in childhood cancers in India and pediatric palliative care in India is an emerging specialty. Prescribing pain and symptom control drugs in children with cancer requires knowledge of palliative care formulary, dosing schedules, and prescription guidelines. This study is a retrospective audit of prescribing practices of a specialist palliative care service situated in a tertiary cancer center.
Methods:
A total of 1135 medication records of children receiving specialist pediatric palliative care services were audited for 5 years (2010-2014) to evaluate prescribing practices in children with advanced cancer.
Results:
A total of 51 types of drugs were prescribed with an average of 4.2 drugs per prescription. 66.9% of the prescriptions had paracetamol, and 33.9% of the prescriptions had morphine. Most common nonsteroidal anti-inflammatory drugs prescribed was ibuprofen (23.9%), and more than 50% of the prescriptions had aperients. The most commonly prescribed aperient was a combination of liquid paraffin and sodium-picosulfate. Dexamethasone was prescribed in 51.9% of patients and in most cases this was part of oral chemotherapy regimen. Generic names in prescription were used only in 33% of cases, and adverse effects of the drugs were documented in only 9% of cases. In 25% of cases, noncompliance to the WHO prescription guidelines was seen, and patient compliance to prescription was seen in 40% of cases.
Conclusions:
Audit of the prescribing practices in specialist pediatric palliative care service shows that knowledge of pediatric palliative care formulary, rational drug use, dosing, and prescribing guidelines is essential for symptom control in children with advanced life-limiting illness. Noncompliance to WHO prescribing guidelines in one fourth of cases and using nongeneric names in two-thirds of prescription indicates poor prescribing practices and warrants prescriber education. Prescription noncompliance by almost two-thirds of patients is alarming and necessitates intense patient, family, and caregiver education and empowerment.
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