STAMP: a 5-year project to reduce paediatric prescribing errors.

We describe an ongoing quality improvement project to reduce paediatric prescribing errors following our earlier interventions previously published.

The problem with gentamicin: reducing administration and prescribing errors in neonates treated for early onset infection with gentamicin.

We describe a quality improvement (QI) project to reduce the number of administration and prescribing errors with gentamicin on a local neonatal unit in a district general hospital, from January 2017 to August 2019. Baseline data collected showed seven errors in the first 16 months of the project (from 1999 doses). The aim of this QI project was to have no low-level, moderate-level or severe level harm errors in the intervention period. A number of interventions were carried out including a change to local guidelines and teaching sessions for staff. All Datix reports for gentamicin were reviewed as well as data collected from the pharmacy team for a further 16 months. One low harm error was reported in this period (from 1938 doses). Education of the medical and nursing staff has been a key intervention in reducing our gentamicin errors as well as changing the way we prescribe gentamicin.

Please reconcile, not wait a while.

A quality improvement project to increase the rate of paediatric medicines reconciliation was carried out in a district general hospital between April and July 2018. Baseline data collected from our paediatric ward shows that medicines reconciliation by doctors is only accurately completed 50% of the time. Evidence shows that medicines-related patient safety incidents are more likely when medicines reconciliation happens more than 24 hours after a person is admitted to an acute setting. The aim of this quality improvement project was therefore to ensure that 100% of paediatric patients have their regular medications prescribed by mid-day the day after admission. The paediatric pharmacy team reviewed all paediatric inpatient drug charts from Monday to Friday for 12 weeks. The number of regular medications and the number of medicines reconciled was recorded each day. The effectiveness of various interventions were reviewed using Plan-Do-Study-Act cycles. On average, 40 patients were reviewed each week. The mean reconciliation rate was 79%, and the worst rate was 0%. 100% reconciliation was achieved on 34 occasions and was achieved continuously for the last 3 weeks of data collection. A repeat audit carried out in September 2018 found the reconciliation rate was maintained at 100%. Multiple interventions occurred during this quality improvement project: teaching sessions for doctors, posters to raise awareness and questionnaires for parents/children to complete about their regular medications. The main factor for success in this project has been involving all members of the paediatric department including children and their parents.

STAMP: a continuous improvement approach to improve paediatric prescribing and medication safety.

We describe an ongoing quality improvement project focusing on paediatric prescribing and medication safety for medical, surgical and oncology patients in a district general hospital. The project is called STAMP-Safe Treatment and Administration of Medicine in Paediatrics. The project has been running continuously for 24 months. No one factor has been identified to sustain a reduction in prescribing error rates. However, we have improved the quality and frequency of feedback to prescribers following errors. We believe that this ongoing project is changing the local prescribing culture, and with further Plan-Do-Study-Act cycles we hope to see improvement in prescribing error rates.

What's age got to do with it? A study of the implementation of the discharge medicines service for paediatric patients.

OBJECTIVES: The discharge medicines service (DMS) was introduced as an essential service for all community pharmacies in England through the Community Pharmacy Contractual Framework (CPCF) in February 2021. This study aimed to describe the implementation of this service for paediatric patients and to identify any barriers to referrals. METHODS: The study was undertaken in a 24-bed paediatric ward in a District General Hospital from September 2022 to February 2023. All paediatric inpatients on long-term medications were eligible for inclusion. Out of 169 eligible participants, 149 were referred. Community pharmacists accessed referrals through PharmOutcomes® and could accept, complete, or reject referrals on this platform. KEY FINDINGS: Of the 149 referred patients, 24 (16.1%) were accepted but not yet actioned; 63 (42.3%) were fully or partially completed; 19 (12.8%) were rejected, and 43 (28.9%) there was no response (remained as referred). Younger children (<2 years) were more likely to have their referral rejected than older children (6 years and older). The feedback from parents was overwhelmingly positive (93.5%) and two families reported that they believed the DMS service prevented readmission to the hospital for their children. No children were involved in the community pharmacist consultation. Barriers to referrals included patients not having a nominated pharmacy and a lack of confidence in completing paediatric referrals. CONCLUSIONS: This study demonstrates the value of completing referrals for paediatric patients. More research is required to explore how community pharmacists can be supported to complete paediatric DMS referrals.

Transition to adult services: the current and potential role of the UK hospital pharmacist.

PURPOSE: To explore the current and potential role for UK pharmacists in the transition to adult services for young people with chronic health problems. METHODS: UK hospital pharmacists were surveyed using an online questionnaire with closed and open questions covering their involvement in a transition programme, demography and scope of work, experiences of transition, and the barriers encountered in providing an effective transition service. RESULTS: Overall, 74 pharmacists completed the questionnaire. Most were female (70% (52/74)), had ≥6 years of experience (62% (46/74)), were paediatric pharmacists (74% (55/74)), and were based in a teaching hospital practice setting (70% (52/74)). Many participants (57% (42/74)) had a transition programme in place in their hospital; of these, 55% (23/42) were not a part of the service. Respondents identified unique skills that pharmacists could contribute to the transition service, including knowledge of medications (including formulations and unlicensed medications), awareness of medication services beyond paediatrics, commissioning of medications, and familiarity with adult services. Most commonly identified barriers to transition included 'time constraints', 'pharmacists not involved as part of the wider multidisciplinary team', and 'lack of engagement between different services'. Pharmacists noted that their ideal transition service would include specific medication-related transition, for example, adherence, counselling, and supply of medications. CONCLUSIONS: These findings support the role of hospital pharmacists as crucial members of the multidisciplinary team required for transition. The skills and knowledge of the hospital pharmacist is under-utilised within the transition service, yet pharmacists are motivated and uniquely skilled healthcare professionals who have the potential to improve medicines transition.

For children admitted to hospital, what interventions improve medication safety on ward rounds? A systematic review.

OBJECTIVE: Every year, medication errors harm children in hospitals. Ward rounds are a unique opportunity to bring information together and plan management. There is a need to understand what strategies can improve medication safety on ward rounds. We systematically reviewed published interventions to improve prescribing and safety of medicines on ward rounds. DESIGN: Systematic review of randomised controlled trials and observational studies. SETTING: Studies examining inpatient ward rounds. PATIENTS: Children and young people aged between 0 and 18 years old. INTERVENTIONS: Any intervention or combination of interventions implemented that alters how paediatric ward rounds review inpatient medications. MAIN OUTCOME MEASURE: Primary outcome was improvement in medication safety on paediatric ward rounds. This included reduction in prescribing error rates, healthcare professionals' opinions on prescribing and improvement in documentation on ward rounds. RESULTS: Three studies were eligible for review. One examined the use of an acrostic, one the use of a checklist, and the other a use of a specific prescribing ward round involving a clinical pharmacist and doctor. None of the papers considered weight-based errors or demonstrated reductions in clinical harm. Reductions in prescribing errors were noted by the different interventions. CONCLUSIONS: There are limited data on interventions to improve medication safety in paediatric ward rounds, with all published data being small scale, either quality improvement or audits, and locally derived/delivered. Good-quality interventional or robust quality improvement studies are required to improve medication safety on ward rounds. PROSPERO REGISTRATION NUMBER: CRD42022340201.

Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome in a paediatric patient taking zonisamide.

We describe the case of an 11-year-old male patient who presented with a new onset of rash after a recent introduction of zonisamide. Drug rash with eosinophilia and systemic symptoms (DRESS syndrome) is a very serious but rare adverse effect of anticonvulsants such as carbamazepine and phenytoin; however, the reported incidence on zonisamide is scant. DRESS syndrome is complex in its presentation. This patient presented with rash, fever, lymphadenopathy, severe skin erythema, oedema and reduced Glasgow Coma Scale (GCS). He was successfully treated with pulsed intravenous methylprednisolone and intravenous immunoglobulin. The patient was discharged home well after a 3-week admission.

Improving the experience of obtaining repeat complex paediatric prescriptions in the UK.

In the UK, medicines for chronic conditions in children and young people (CYP) are typically initiated within secondary or tertiary care, with responsibility for ongoing supply often then passed to the child's general practitioner (GP) and community pharmacist. The patient should then be reviewed in regular specialist clinics, with two-way communication for any changes in medications or clinical status undertaken between primary and secondary/tertiary care. This arrangement allows long-term medications to be obtained close to home.Although this is what parents expect, the reality is often messy, with families regularly needing to source some medicines from the GPs and others via hospitals or homecare services. In addition, these arrangements are not uniform, they vary across different areas of the UK and depend on individual GP or hospital prescriber acceptance. When neither primary, secondary or tertiary care accepts it is their responsibility to prescribe, or patients are under multiple specialists, families often feel left to navigate this complex and variable supply system themselves. Obtaining a prescription is only the start of the process for families as dispensing from a community pharmacy can also be challenging.In this article, we set out the barriers and potential solutions to this complex issue. We use the term specialist prescribers to include not only paediatricians but all other specialists looking after CYP including child and adolescent psychiatrists, ophthalmologists, dermatologists, surgeons, etc, as well as non-medical prescribers.