1. Medication Safety Alice Roueché: Consultant Paediatrician
Steve Tomlin: Consultant Pharmacist
Evelina London Children’s Hospital

2. Why focus on medications?
What is the excess number of child deaths in the UK compared to Sweden?
A. 5
B. 3
C equal
What % of reported errors are medication related?
A. 5%
B 15%
C 20%
What is the frequency of harm from medication errors in neonates and children compared to adults?
A. Equal
B. x3
C. x5

4. Medication reconciliation
the process of creating the most accurate list possible of all medications a patient is taking — including drug name, dosage, frequency, and route — and comparing that list against the physician’s admission, transfer, and/or discharge orders, with the goal of providing correct medications to the patient at all transition points within the healthcare system. IHI

5. Or
What we think is happening Vs
What is actually happening

6. Asthma across the boundaries

7. Case 6 year old boy Diagnosed with asthma 6/12 ago Broken rib 5/7 ago
Shortness of breath while at home and brought to A&E
Required nebulisation and still a bit wheezy and thus admitted over night

8. Meds Rec taken from mum (no meds brought in)
Salbutamol prn
Beclomethasone 100 (brown) bd
Regular paracetamol and ibuprofen for pain and another liquid prn
Via a spacer
How much salbutamol
Beclomethasone – is it Clenil as the Qvar is twice as potent
Beclo – is it 100 1puff bd or 2 puffs bd or is it actually a 50 I puff bd
What sort of spacer
With or without mask
Compliance and knowledge of looking after spacer and use of puffers
Prn pain control – oramorph – leading to this attack??

9. Prescription at Discharge and sent to GP
Salbutamol 10 puffs prn
Seretide 50 2 puffs Twice daily
Prednisolone 40mg od
What is the reducing schedule for salbutamol
Do the meds actually need to change, based on med rec compliance and use of spacer and devise?
How long should they stay on seretide bd? – usually reduce to od
No spacer prescribed
What is the length of course of the pred
How is the pred to be given and what are the issues

10. First Prescription from the GP, 4/52 Post Discharge a
Salbutamol 4 puffs prn
Seretide 50 2 puffs bd
Beclomethasone 50 2 puffs bd
Reducing course of salbutamol not understood and GP carries on with where they say they have got to
Seretide 50 – should be dropped to od
Beclomethasone – re-prescribed as still on the GP system from before admission
No spacers prescribed or used

11. In groups For each step consider What are the risks?
What information is needed?
How is information being transferred?
What is the parent/child perspective?
Ideas for improving the process

12. Meds IQ