Safety of Medication in Paediatrics
Background: In paediatrics, the limited documentation to guide medication, the lack of suitable dosage forms, and the continuous development in childhood present a scenario where safety of medication is a particular challenge. Aim: To explore reported adverse drug reactions (ADRs) and the challenges...
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Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap
2013
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ndltd-UPSALLA1-oai-DiVA.org-uu-1973232013-08-31T05:00:13ZSafety of Medication in PaediatricsengStar, KristinaUppsala universitet, Institutionen för folkhälso- och vårdvetenskapUppsala2013paediatricsadverse drug reactiondrug-related problemmedication errorpatient safetyindividual case safety reportspharmacovigilancemedicationnurseshealth care personneldosage formNSAIDdosingprescriptionantipsychotic medicinespostmarketing surveillanceBackground: In paediatrics, the limited documentation to guide medication, the lack of suitable dosage forms, and the continuous development in childhood present a scenario where safety of medication is a particular challenge. Aim: To explore reported adverse drug reactions (ADRs) and the challenges in prescribing and administering medicines in paediatrics, in order to identify and suggest areas needing international surveillance within medication safety and improvement in the clinical setting. Methods: Four exploratory studies were conducted. Worldwide reporting of suspected ADRs (individual case safety reports, ICSR) with ages 0-17 years were examined overall. Twenty published case reports and ICSRs for adolescents, who developed a rare and incompletely documented ADR (rhabdomyolysis) during antipsychotic medicine use, were analysed in-depth. Prescribed doses of anti-inflammatory medicines were studied in a UK electronic health record database. Transcribed focus group interviews with 20 registered nurses from four paediatric wards in Sweden were analysed for factors that may promote or hinder safe medication practices. Descriptive statistics, multiple regression, and content analyses were used. Results: Although, skin reactions and anti-infective medicines were most frequently reported, and more reported in paediatric patients than in adults, medication errors and adverse reactions related to psychostimulant medicines were reported with increased frequency during 2005 to February 2010. The in-depth case analysis emphasised the need for increased vigilance following changes in patients’ medicine regimens, and indicated that ICSRs could contribute with clinically valuable information. Prescribed dose variations were associated with type of dosage form. Tablets and capsules were prescribed with a higher dose than liquid dosage forms. Six themes emerged from the interviews: preparation and administration was complex; medication errors caused considerable psychological burden; support from nurse colleagues was highly valued; unfamiliar medication was challenging; clear dose instructions were important; nurses handling medications needed to be accorded higher priority. Conclusions: Age-specific screening of ICSRs and the use of ICSRs to enhance knowledge of ADRs and medication errors need to be developed. Access to age-appropriate dosage forms is important when prescribing medicines to children. To improve medication safety practices in paediatric care, interdisciplinary collaborations across hospitals on national or even global levels are needed. Doctoral thesis, comprehensive summaryinfo:eu-repo/semantics/doctoralThesistexthttp://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-197323urn:isbn:978-91-554-8632-7Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, 1651-6206 ; 883application/pdfinfo:eu-repo/semantics/openAccess |
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English |
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Doctoral Thesis |
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paediatrics adverse drug reaction drug-related problem medication error patient safety individual case safety reports pharmacovigilance medication nurses health care personnel dosage form NSAID dosing prescription antipsychotic medicines postmarketing surveillance |
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paediatrics adverse drug reaction drug-related problem medication error patient safety individual case safety reports pharmacovigilance medication nurses health care personnel dosage form NSAID dosing prescription antipsychotic medicines postmarketing surveillance Star, Kristina Safety of Medication in Paediatrics |
description |
Background: In paediatrics, the limited documentation to guide medication, the lack of suitable dosage forms, and the continuous development in childhood present a scenario where safety of medication is a particular challenge. Aim: To explore reported adverse drug reactions (ADRs) and the challenges in prescribing and administering medicines in paediatrics, in order to identify and suggest areas needing international surveillance within medication safety and improvement in the clinical setting. Methods: Four exploratory studies were conducted. Worldwide reporting of suspected ADRs (individual case safety reports, ICSR) with ages 0-17 years were examined overall. Twenty published case reports and ICSRs for adolescents, who developed a rare and incompletely documented ADR (rhabdomyolysis) during antipsychotic medicine use, were analysed in-depth. Prescribed doses of anti-inflammatory medicines were studied in a UK electronic health record database. Transcribed focus group interviews with 20 registered nurses from four paediatric wards in Sweden were analysed for factors that may promote or hinder safe medication practices. Descriptive statistics, multiple regression, and content analyses were used. Results: Although, skin reactions and anti-infective medicines were most frequently reported, and more reported in paediatric patients than in adults, medication errors and adverse reactions related to psychostimulant medicines were reported with increased frequency during 2005 to February 2010. The in-depth case analysis emphasised the need for increased vigilance following changes in patients’ medicine regimens, and indicated that ICSRs could contribute with clinically valuable information. Prescribed dose variations were associated with type of dosage form. Tablets and capsules were prescribed with a higher dose than liquid dosage forms. Six themes emerged from the interviews: preparation and administration was complex; medication errors caused considerable psychological burden; support from nurse colleagues was highly valued; unfamiliar medication was challenging; clear dose instructions were important; nurses handling medications needed to be accorded higher priority. Conclusions: Age-specific screening of ICSRs and the use of ICSRs to enhance knowledge of ADRs and medication errors need to be developed. Access to age-appropriate dosage forms is important when prescribing medicines to children. To improve medication safety practices in paediatric care, interdisciplinary collaborations across hospitals on national or even global levels are needed. |
author |
Star, Kristina |
author_facet |
Star, Kristina |
author_sort |
Star, Kristina |
title |
Safety of Medication in Paediatrics |
title_short |
Safety of Medication in Paediatrics |
title_full |
Safety of Medication in Paediatrics |
title_fullStr |
Safety of Medication in Paediatrics |
title_full_unstemmed |
Safety of Medication in Paediatrics |
title_sort |
safety of medication in paediatrics |
publisher |
Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap |
publishDate |
2013 |
url |
http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-197323 http://nbn-resolving.de/urn:isbn:978-91-554-8632-7 |
work_keys_str_mv |
AT starkristina safetyofmedicationinpaediatrics |
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1716596943353806848 |