Recommendations for the safe use of high-risk medications in pediatrics

The objectives of this consensus document were to establish a standardized list of high-risk medications for the pediatric population and to compile the recommended practices for their safe use with the aim of promoting the implementation of medication error prevention programs in health care centers.

The Ministry of Health, the Spanish Institute for Safe Medication Practices, the Spanish Association of Pediatrics and the Spanish Society of Hospital Pharmacy and regional administration representatives participated in the project. The Recommendations for the Safe Use of High-Risk Medications was used as reference, and its contents adapted and expanded to address specific issues in the pediatric population based on the current evidence.

The document provides a reference list of high-risk medicines in pediatric care. It recommends that health care centers, in addition to prioritizing interventions in relation to anticoagulants, insulins, opioids, neuromuscular blockers, IV potassium, oral methotrexate and cytostatic agents, also consider interventions for IV adrenergic agonists, aminoglycosides and vancomycin, drugs for moderate and minimal sedation, parenteral nutrition and IV paracetamol in pediatric patients. The document emphasizes the need to implement multiple safe practices at every stage of the medication use process, prioritizing those with the greatest effectiveness, and involving pediatricians, pharmacists and other healthcare professionals. It also highlights the importance of active involvement by patients and caregivers. Finally, it provides general guidelines common to all these medications, as well as specific practices for each prioritized pharmacological group or medication, which should be combined to enhance pediatric patient safety.

Developing programs to increase the safety of high-risk medications in pediatric patients is essential in order to reduce medication errors in this vulnerable population. The implementation of safe practices should be accompanied by continuous monitoring and periodic updates to guarantee effectiveness and strengthen the safety culture in health care centers.