Abstract
BackgroundA lack of age-appropriate formulations can make it difficult to administer medicines to children. A manipulation of the dosage form may be required to achieve the required dose. This study aimed to describe medicines that are manipulated to achieve the required dose in paediatric practice.MethodA structured, undisguised observational study and postal survey. The observational study investigated drug manipulations occurring in clinical practice across three sites. The questionnaire, administered to a sample of paediatric nurses throughout the UK, surveyed manipulations conducted and nurses’ experiences and views.ResultsThe observational study identified 310 manipulations, of which 62% involved tablets, 21% were intravenous drugs and 10% were sachets. Of the 54 observed manipulations 40 involved tablets with 65% of the tablets being cut and 30% dispersed to obtain a smaller dose. 188 manipulations were reported by questionnaire respondents, of these 46% involved tablets, 12% were intravenous drugs, and 12% were nebuliser solutions. Manipulations were predominantly, but not exclusively, identified in specialist clinical areas with more highly dependent patients. Questionnaire respondents were concerned about the accuracy of the dose achieved following manipulations and the lack of practice guidance.ConclusionManipulations to achieve the required dose occur throughout paediatric in-patient settings. The impact of manipulations on the efficacy of the drugs, the accuracy of the dose and any adverse effects on patients is not known. There is a need to develop evidence-based guidance for manipulations of medicines in children.
Highlights
A lack of age-appropriate formulations can make it difficult to administer medicines to children
A systematic review completed in this area [13] identified only one study that was not related to splitting tablets
Studies in the systematic review included drugs which are used in paediatric practice, though there were only two papers that included paediatric participants
Summary
A lack of age-appropriate formulations can make it difficult to administer medicines to children. This study aimed to describe medicines that are manipulated to achieve the required dose in paediatric practice. A lack of commercially-available, age-appropriate formulations makes it difficult to administer medication to children accurately [1,2,3,4]. Medicines are manipulated by the physical alteration of a dosage form with the aim of achieving the required (usually smaller) dose for administration. A systematic review completed in this area [13] identified only one study (involving suppositories) that was not related to splitting tablets. Studies in the systematic review included drugs which are used in paediatric practice, though there were only two papers that included paediatric participants.
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