Children are more susceptible to harm from medicines due to a number of factors.
Why does this standard need special consideration by health service organisations that provide care for children?
Children are more susceptible to harm from medicines because:
- The absorption, distribution, metabolism and excretion of medicines in children varies with age
- Children’s weight varies with growth and changing activity levels
- The dosage of medications for children is often nonstandardised and weight-dependent
- There may be difficulties associated with administering medications to children
- Children’s capacity to communicate medication problems when they occur is variable.
Criterion: Clinical governance and quality improvement to support medication management
Organisation-wide systems are used to support and promote safety for procuring, supplying, storing, compounding, manufacturing, prescribing, dispensing, administering and monitoring the effects of medicines.
Integrating clinical governance
To reduce the risk of harm from medicines, health service organisations that provide care for children could implement policies to ensure the use of:
- Validated paediatric medication charts, such as the Paediatric National Inpatient Medication Chart28
- Independent double-check of paediatric medicines and calculations by a second clinician before administration29,30
- Child-based protocols, formulary approval processes and evaluation processes for ‘of-label’ medicine use31,32
- Burettes to deliver intravenous fluids
- Safe, non-disrupted.
Evidence shows that incorrect recording of a child’s weight can contribute to incorrect dose calculation.33 To reduce this risk, health service organisations that provide care for children may consider ensuring that:
- A child’s height, length and weight are documented and dated upon admission
- Accurate, current weight in kilograms is documented clearly on all medication charts
- Processes are in place to regularly weigh children and then track any variation in weight during an episode of care
- Estimated weights are not used except in lifesaving situations; when they are used, use of tools to estimate weight should be considered
- Regularly calibrated age-appropriate medical-grade weighing scales are available in all areas that provide care for children.
The health service organisation should ensure that clinicians caring for children have the skills to accurately and safely calculate dosage and volumes of medicines for children. If necessary, training and awareness programs should be available to improve clinician competency.
Health service organisations should also ensure that all clinicians who prescribe are equipped with knowledge and skills in the main general principles of safe prescribing and medicines use in the children.
Partnering with consumers
Medicine dosing errors at home are more likely to occur when there are low levels of health literacy.34 It is estimated that approximately 40% of adults have the level of health literacy that enables them to meet the challenges of everyday life.35 Therefore, health service organisations may consider ensuring that the person taking responsibility for care at home, whether adult or child, knows how to accurately and safely administer medicines.36 For some populations, including people from culturally and linguistically diverse backgrounds, and Aboriginal and Torres Strait Islander people, medicines information may need to be translated into other languages and presented in a form that is meaningful. This translation of information can reduce the risk of a medicine-related adverse event following discharge.
Criterion: Continuity of medication management
A patient’s medicines are reviewed, and information is provided to them about their medicines needs and risks. A medicines list is provided to the patient and the receiving clinician when handing over care.
Information for patients
Health service organisations should ensure that high-quality medicines-related information is available to children and their families. This helps them better understand their roles and responsibilities for medication management, and assists with pharmacovigilance.* It includes presenting information on medicines in graphic, photographic or pictorial form, which has been shown to improve the safe use of medicines by people with low health literacy.34
Health service organisations should evaluate the content and usefulness of medicines-related information to ensure its suitability for children and family members by:
- Involving children and their families in the development of locally produced materials and approaches to distribution
- Inviting children and their families to provide feedback on available medicines-related information
- Using this feedback to improve medicines-related information materials and distribution practices.
*Pharmacovigilance is the science and procedures relating to the detection, assessment, understanding and prevention of adverse effects or any other drug-related problem.37
Criterion: Medication management processes
Health service organisations procure medicines for safety. Clinicians are supported to supply, store, compound, manufacture, prescribe, dispense, administer, monitor and safely dispose of medicines.
Information and decision support tools for medicines
Health service organisations should ensure that:
- Appropriate dosing guidelines for medicines used for children are readily available to clinicians – for example, weight-based resuscitation dosage guidelines
- Age- and weight-based guidelines are available and used for the administration of all medicines for children, regardless of route
- The standard set of medicines-related reference materials, including children’s medicines information and dosing guidelines, is available for use by all clinicians who prescribe, dispense and administer medicines to children.
Health service organisations should ensure that appropriate paediatric reference texts and guidelines are available in case more detailed information on optimising paediatric prescribing is needed or special patient cohorts must be dealt with. For example:
- When dosing obese children, use of ‘ideal weight’ may be more appropriate for some medicines
- When dosing older children (or those over 40–50 kg), care should be taken to ensure that the upper dose limits for adults are not exceeded.
It is important for health service organisations to review relevant literature, data and information on medication safety incidents to identify any high-risk medicines that require specific management guidelines for children.38,39
Take extra care with children to ensure that the correct dose of a high-risk medicine is administered. To further improve the management of high-risk medicines and meet the safety needs of children, health service organisations could:
- Make a list of high-risk medicines specific to children
- Identify related policies, procedures and protocols for the administration of high-risk medicines to children – for example, syringes for administration of medication should have minimal dead space40
- Implement an independent double-check policy for administration of paediatric medicines
- Ensure that guidelines and decision support tools for the prescribing and administration of high-risk medicines to children are readily available and used by clinicians
- Check with the child and their family that they fully understand the medication order and administration of the medicines before a high-risk medicine is taken home; families and children play a major role in identifying medication errors before they occur, and early detection can prevent a medication error causing harm.