Lack of training in prescribing medicines for children

Current training and assessment for curbing common pitfalls in medicines prescribing for children is inadequate, suggests research published ahead of print in Archives of Disease in Childhood.

The authors base their findings on a trawl of published research on techniques to reduce prescribing errors and a survey of relevant healthcare professionals and medicines researchers on training methods.

Children pose particular prescribing problems, say the authors, because the absence of formulations designed specifically for them means that doses have to be individually calculated, increasing the chances of error.

And children are particularly vulnerable to the consequences of a mistake.

Previous research also shows that junior doctors often feel inadequately prepared to prescribe confidently, or don't know which drugs to prescribe for conditions, such as chest infections or anaphylaxis (life threatening allergic reaction).

The authors found little published research on either the teaching of prescribing skills or the ways in which competencies are assessed, and came up with just two relevant studies.

These showed that the error rate fell after particular techniques were introduced, but it was impossible to tell from the conclusions which had proved most effective.

A total of 319 out of 559 questionnaires were returned for the survey, giving a response rate of 57%.

The responses showed that training in how to avoid mistakes in prescribing medicines for children was brief and predominantly in lecture format. There was little practical, hands on training.

Eleven centres taught how to complete a drug chart, while seven discussed common prescribing errors. And one centre provided a computer based prescribing course on how to calculate drug doses correctly.

But in 13 centres training took the form of a presentation by specialist pharmacists, lasting between 30 and 60 minutes, mostly at induction. And 10 centres provided trainees with an induction pack containing written information.

Only three centres tested prescribing competency, using workbooks, questions during lectures, or formal testing.

The authors acknowledge that their research may not reflect a comprehensive picture of prescribing training, but there is currently no validated method of assessment, nor any national standards on the teaching of prescribing medicines for children, they say.

And they suggest that at the very least it is important to find out which teaching methods work best to cut errors, if indeed any are effective.