1. Medicines for Children Paediatric Palliative Care For Home Based Carers Funded by British High Commission, Pretoria Small Grant Scheme

2. Children with HIV  Need to prevent infections  Need to treat infections  Need to manage symptoms  May need to manage side effects of drugs  So, they usually need lots of medicines

3. Types of Medicines Preventing Infections  Bactrim, Vitamins, Immunisations, ARVs Treatment for infections  Antibiotics, Antifungals Symptom Management  Analgesia, Anti-pyretics, Anti-diarrhoeals, Anti-emetics, Management of Side Effects  Antihistamine, Anti-diarrhoeals, Anti-emetics

4. Other Types of Medicine Home Remedies  ? Traditional Medicines  ? Herbal Remedies  ? ©TALC

5. Medicine Chain Prescription  Certain medicines can be prescribed by Doctor only  Some Professional nurses may prescribe with special training Dispensing  Prescription is prepared by a pharmacist  Ensures correct drugs, dosage and timing of doses is in a labelled container for patient Administering  Professional nurses may administer drugs to patient  Care givers may only do this under supervision of Professional Nurse

6. Scope of Practice Your scope of practice means you will not usually be administering pharmaceutical medicines, but you have a vital role!  Children MUST get the medicines they are prescribed  If they don’t they can’t work! Check the child has access to and is getting the drugs Assess whether carer knows how to give them correctly Refer any concerns to the Professional Nurse Ensure any side effects are reported immediately Reinforce the importance of completing the course to the carer Support the carer in giving the medicines

7. Caution  Medicines which are not used correctly can be dangerous  The sale, prescription and dispensing of medicines is controlled by law  All medicines which are sold to the public must be tested and registered with the Medicines Control Council

8. Medicines Control Council Schedule 1 and 2  Aspirin, Vitamins, Milk of Magnesia  Can be bought at supermarkets and cafes Schedule 3  Can only be bought by an adult from a pharmacy Schedule 4  Can only be obtained on the prescription of a doctor from a pharmacy Schedule 5,6 and 7  Must be prescribed by a doctor, dispensed by a pharmacist and prescription renewed every time (Department of Health, 1997)

9. Side Effects Be aware of the more common side effects of medicines You need to be able to:  Recognise them if a child experiences them  Refer the child for appropriate management  Teach the carer about common side effects of the medicines  Teach her when to seek advice  Ensure the side effects have been managed appropriately  Refer again if they have not

10. Expiry Date  Medicines are all marked with a date  They MUST be used before that time or they may be harmful or of no use 04Jul06

11. Adherence If the medicines are to work, they must be taken All medicines must be taken in exactly the way they have been prescribed This is known as adherence You have a vital role in assessing:  Assessing whether the child is adherent to the medication  Identifying any causes of non-adherence  Supporting the carer  Referring any concerns

12. Causes of Non-adherence A child is dependent on the carer. If the carer:  Does not understand the importance of the medicines  Does not know which medicines to give to the child and when  Does not know how to give the medicines to the child  Is unable to remember to give the medicines  Does not believe the child should have them  Is unable to collect the medicines  Is unable to get the child to take the medicines  Thinks the child is better now so stops the medicines The child may be non-adherent!

13. 5 Golden Rules  The right patient  The right medicine  The right dose  The right route  The right time These apply to everybody but… They are even more important when giving medicines to children! (Department of Health, 1997)

14. The Right Patient The only person who should receive the medicines prescribed by the doctor, dispensed by the pharmacist and administered by the professional nurse is the child whose name is on the bottle/box/bag

15. The right medicine  If the wrong medicine is given to a child, this could also be very dangerous  The wrong medicine may not treat or prevent infection, manage symptoms or side effects  Some medicines should not be given to children  The child may be allergic to that drug

16. The Right Dose  Children are much smaller than adults  Their bodies have different ways of coping with medicines  Drug doses are extremely carefully calculated for children so: Drugs achieve their aim but do not harm the child  Doses are calculated by weight (and sometimes height)  Children grow quickly so need regular monitoring of weight

17. The Dose  You MUST give an accurate dose!  NEVER guess the amount to give  NEVER just pour syrup in to the child’s mouth  This could be dangerous for the child: - He may get too much medicine - He may get too little medicine

18. Measuring The Right Dose Different methods may be used to measure accurate doses of syrups or liquids before giving them to the child  Droppers  Marked Medicine Cap  Medicine Cup  Syringe  Spoon

19. The Right Route Medicines must always be given by the correct route Medicines may be administered in the following ways:  By mouth  Under the tongue  On the skin  In to the eye  Into the nose  In to the rectum  By injection  By inhalation

20. The Right Route  The route by which drugs are given to children is extremely important  Children do not like medicines  May cause trauma and distress to both the child and the carer  If the child cannot/will not take the medicines, they cannot work  The way medicines are given can have a great impact on a child’s quality of life

21. Medicines By Mouth Most medicines given to a child will normally be given by mouth They come in the form of:  Pills and tablets  Capsules  Suspensions/mixtures  Syrup  Drops

22. Helping the Child Take Medicine  If the medicines are to work, the child must be able to swallow them  A child may have been dispensed medicine that he cannot swallow  This causes unnecessary distress for the child and the carer  The child will not get the medicines he needs

23. Giving Medicines to a Child If the medicines are to work, the child needs you to make regular assessments  Does he like the taste of the medicine?  Is he able to swallow the tablets?  Can he tolerate the volume of syrup?

24. Giving the Medicine  Medicine Cups  Syringes (1ml, 2.5ml, 5ml, 10ml)  Spoon  Plastic dropper ©TALC

25. Giving the Medicine Need to prevent aspiration  Hold child in semi-reclining position  Place medicine in spoon, plastic cup, plastic dropper, plastic syringe (without needle!)  Place medicine along side of infant’s tongue  Administer slowly  Wait for child to swallow

26. Handy Hints! Some medicines are only available as tablets or capsules Handy Hints for Children!  Crush tablet if possible/allowed  Mix with jam, porridge  Divide tablet if scored  Empty capsule and sprinkle contents on jam (only allowed for some drugs!)

27. Handy Hints!  Talking with the Child  Taking Medicines Together  Sticker Charts  Play Therapy

28. Nasogastric Administration  Oral medications may be given via NG tube  Removes distress of giving medicines  Does not disturb the child  Medicines in liquid form or safe to crush only  Risk of clogging the tube  Always flush tube with clean water

29. Rectal Administration  Useful for children unable to take anything by mouth  Sedatives, analgesia, anti-pyretic, anti-emetics, anti- convulsants  Often absorbed more quickly and quicker response  Faeces may delay absorption  Unsuitable for child with diarrhoea

30. Eyes, Ears & Nose  Not usually painful but drugs can cause unpleasant sensation  Usually distressing for a child  Difficult for carer to gain child’s cooperation  Infant and young child need to immobilise head  Older child needs explanation and direction

31. The Right Time Medicines must be given at the right time or they will not be effective Medicines may be ordered  4 hourly (06h00, 10h00, 14h00, 18h00, 22h00)  6 hourly (06h00, 12h00, 18h00, 24h00)  Daily (in the morning, after breakfast)  Every evening (at bed time)  Three times a day (usually after meals)  Twice a day (after breakfast and supper) Medicines must never be given more often than prescribed as this could be dangerous for the child

32. The Right Time Note!  Some drugs must be taken on an empty stomach or with food  These instructions MUST be adhered to  Otherwise the drugs will not work or may be harmful to the child  The importance of this must be explained to the carer  This can cause difficulties for carers when children want to eat / do not want to eat

33. Summary Working within your scope of practice, you are not usually involved in administering of medicine But You have a vital role in ensuring the children are receiving their medicine, safely and accurately and that any problems are referred