Paediatric Prescribing

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Paediatric Prescribing

• Suzy Heafield

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Pharmacy Department at QMC

• Where? Paediatric satellite (Outpatients at
  weekends)
• All paediatric wards have a visit by a clinical
  pharmacist (bleep numbers on ward)
• Look at completeness accuracy of prescription
  and monitor for contraindications, correct
  dosing, side effects interactions
• Hours 0900 to 1700 Monday to Friday (on-call
  pharmacist available for whole hospital outside
  these times)

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On-call

• No TTOs after 6pm except Short Stay Unit and
  Oncology ward attenders
• No TTOs after midnight
• Nurse dispensing on SSU for paracetamol,
  ibuprofen, salbutamol and dioralyte (will include
  other items soon)
• Always available for advice!
• If starting new medication after 8pm Dr must
  contact pharmacist (only if urgent)
• No pharmacist on site after midnight

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Pharmacy Department (2)

• Other areas of pharmacy
• Medicines information
• Sterile production unit TPN, CIVAS,chemotherapy
• Non-sterile manufacturing unit can make some
  products not available commercially

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NUH Guidelines

• Medicines code of practice
• IV guide yellow pages. Currently being
  reprinted
• Paediatric policies

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Paediatric Formularies

• If no policy
• Dont use adult BNF!
• C-BNF is first line reference source - available
  on all paed wards. (Paed policy doses may differ
  from C-BNF e.g. ceftriaxone)
• Medicines for Children may contain some drugs not
  in C-BNF

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Dangerous Medicines

• Aminoglycosides monitoring!
• Aminophylline
• Amiodarone
• Cytotoxic drugs SHOs do not prescribe
• Digoxin
• Insulin
• Morphine other opiates
• Phenytoin
• Potassium - NPSA

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Good Prescribing Guidelines

• Always write in black indelible ink
• Always write in block capitals must be legible
• Doses are prescribed using only g(grams),
  mg(milligrams), micrograms(in full), units(in
  full)
• Write in dose you are using expressed as per kg
• Carry forward original starting date when
  re-writing charts
• If possible prescribe drugs on a single chart. If
  not, number charts and tie together

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Good Prescribing Guidelines

• Always rewrite a prescription when dose or timing
  altered
• Always use a calculator
• Always refer to the drug administration manual,
  policy file or hospital codes of practice
• Dont rush take your time check your
  calculation
• Use rINNs

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Drug Chart

• Essential
• Name / DOB / Hospital number
• Correct weight
• Allergy box must be signed before a drug can be
  administered

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TTOs

• Write number of days required, particularly
  antibiotics and steroids
• Use dose-banding guidelines for paracetamol and
  ibuprofen parents find it difficult to measure
  6.32ml!
• Prescribe as early as possible ideally 24 hours
  before discharge

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Any questions?