Paediatric Prescribing Suzy Heafield

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)

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

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

NUH Guidelines Medicines code of practice IV guide – yellow pages. Currently being reprinted Paediatric policies

Paediatric Formularies If no policy: Don’t 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

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

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

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 Don’t rush – take your time & check your calculation Use rINNs

Drug Chart Essential: – Name / DOB / Hospital number – Correct weight – Allergy box – must be signed before a drug can be administered

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

Any questions?