Project could lead to fall in prescribing errors for children

Initiatives aimed at cutting the number of errors made when prescribing medicines to children are the focus of a project being led by researchers at The University of Nottingham and The School of Pharmacy, University of London.

The COSMIC (Cooperative of Safety of Medicines in Children) study is surveying hospitals around the country to find out more about the practices they use to try to reduce mistakes in the doses of medicines given to children.

The 18-month project will choose a small number of initiatives to study in depth. It will culminate in a report to the Department of Health, which is funding the project with a grant of £125,000, making recommendations on which of the most successful schemes would be suitable to be introduced across the NHS.

Prescribing for children can be difficult as formulations of medicines are mainly designed with adults in mind. Working out the equivalent dosage for children — which could range from a tiny amount for a premature baby to a larger amount equivalent to the adult dose for a teenager — involves complex calculations, leading to a greater chance that errors can creep in.

The initial phase of the study has involved a full literature review, so the researchers could find out as much as possible about any initiatives to prevent errors that are already in the public eye. It revealed that little is currently being done to study prescribing and dosing errors in children in the UK.

Sharon Conroy, in the Division of Child Health, based at The University of Nottingham's Medical School in Derby, is leading the project together with Professor Ian Wong at The School of Pharmacy in London.

Mrs Conroy said: “There is a big gap in research in this area, but what we do know is that children are estimated to be three times more likely to be affected by prescribing errors in hospital compared to adult patients. We also know that children may receive up to 10 times the correct dose when mistakes are made, which can have devastating consequences.

“The main reason it's an issue is because every dose for a child has to be worked out on an individual basis, based on their weight, involving complicated calculations. Errors can lead to the child receiving an overdose, or not receiving enough of the drug, meaning it may take them longer to get better.”

Professor Wong continued: “As highlighted by the recent House of Lords' report that most medicines used in children have not yet been tested in children, the Department of Health has recently set up the Medicines for Children Research Network (MCRN) to increase clinical trials.

“Our research complement's the MCRN's work and we look forward to making recommendations on tried and tested ways to reduce calculation errors in children's medicines.

As part of the study, the researchers have contacted 250 paediatric pharmacists and 500 paediatricians asking them to fill in a questionnaire about what their hospital is doing to reduce the risk of dose miscalculations in children. The exercise has identified around 530 different initiatives being used and the researchers have picked 20 of the best to study in depth.

Members of the research team will spend between two and five days at each hospital looking at how the initiatives are run in practice. They will be conducting interviews with nurses, doctors and pharmacists to find out whether they would recommend their initiatives and explore any difficulties they may have experienced while working with them. In particular, they will be asking questions about whether any specialist equipment or techniques are needed, whether it has decreased errors and whether it has the backing of the hospital trust.

Among the initiatives that have been revealed are:

• The use of electronic prescribing rather than paper prescriptions. This could reduce errors as some systems will calculate doses if a patient's weight is input and there is no room for a misreading of a doctor's handwriting.
• A quiet room where doctors and nurses can do their prescribing and dose calculations without being distracted, possibly leading to fewer errors
• Education packages and testing procedures that check that doctors can prescribe accurately for children before being allowed to prescribe on hospital wards.

At the end of the project, the researchers will make recommendations to the Department of Health on which initiatives offer a 'best practice' solution for hospitals and other healthcare providers across the country.

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