Manipulating tablets and capsules given to hospitalised children in Norway is common practice

Bjerknes, Kathrin; Bøyum, S; Kristensen, Solveig; Brustugun, Jørgen; Wang, Siri

doi:10.1111/apa.13700

Cited by 42 publications

(56 citation statements)

References 23 publications

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“…Within our study, this was observed for both ciprofloxacin tablets and itraconazole liquid. Both the reasons and methods used for manipulation by parents and caregivers and nurses were similar to the Norwegian and UK studies, with taste being the most cited barrier to administration in the outpatient setting .…”

Section: Discussionmentioning

confidence: 57%

“…An electronic questionnaire was built using the web‐based LimeSurvey version 2.06 (LimeSurvey GmbH, Hamburg, Germany). The questions were derived from sources regarding the manipulation of medicines for paediatric administration, such as the MODRIC guidelines, and additional research regarding manipulation of medication in children . Questions gave insight into the extent, reasons and methods of manipulation of oral dosage forms for children by parents and caregivers, and included six topics: demographic data, current medication, methods and reasons for manipulation, medication adherence in relation to manipulation, the possible combined administration of oral medicines and the sources of information consulted regarding manipulation.…”

Section: Methodsmentioning

confidence: 99%

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Manipulation of oral medication for children by parents and nurses occurs frequently and is often not supported by instructions

et al. 2019

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Aim: Due to a lack of age-appropriate formulations, administration of drugs to children remains a challenge. This study aimed to identify the problems experienced in both the outpatient setting and the clinical setting.prospective study at the Sophia Children's Hospital, The Netherlands. The study comprised of a structured interview on drug manipulations with parents visiting the outpatient clinic, and an observational study of drug manipulations by nurses at the wards.Results: A total of 201 questionnaires were collected, accounting for 571 drugs and 169 manipulations (30%). Drug substances that were most often mentioned as manipulated were macrogol (n = 23), esomeprazole (n = 15), paracetamol (n = 8), methylphenidate (n = 7) and melatonin (n = 7). Of all manipulated medicines, 93/169 (55%) were manipulated according to the instructions or recommendations of the Summary of Product Characteristics (SmPC) or patient information leaflet. During the observational study, manipulation was performed by 21/35 of observed nurses (60%), of whom 11 deviated from the hospital protocol for manipulation or SmPC (52%). Conclusion:Manipulation was a widely used method to administer drugs to children.Validated information regarding manipulation of drugs for both parents and nursing staff is needed.This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.Oral drug manipulation for paediatric patients van der Vossen et al.

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Section: Discussionmentioning

confidence: 57%

Section: Methodsmentioning

confidence: 99%

Manipulation of oral medication for children by parents and nurses occurs frequently and is often not supported by instructions

et al. 2019

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“…The lack of age-appropriate medicines is also generating the need to physically modify drug products. This manipulation concerns mainly solid oral dosage forms and is done to enable the administration of an appropriate dose or enhance medicine administration [3,4]. The typical methods for manipulating solid dosage forms are the splitting and crushing of tablets, opening of capsules and dispersing powder in liquid or food [4].…”

Section: Introductionmentioning

confidence: 99%

A Focus Group Study about Oral Drug Administration Practices at Hospital Wards—Aspects to Consider in Drug Development of Age-Appropriate Formulations for Children

et al. 2020

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Oral drug administration to pediatric patients is characterized by a lack of age-appropriate drug products and the off-label use of medicines. However, drug administration practices at hospital wards is a scarcely studied subject. The aim of this study was to explore the oral drug administration practices at pediatric hospital wards, with a focus on experiences and challenges faced, methods used to mitigate existing problems, drug manipulation habits, perceptions about oral dosage forms and future needs of oral dosage forms for children. This was a qualitative study consisting of focus group discussions with physicians, nurses and clinical pharmacists in a tertiary university hospital with the objective of bringing forward a holistic view on this research topic. These healthcare professionals recognized different administration challenges that were classified as either dosage form-related or patient-related ones. A lack of depot formulations developed especially for children as well as oral pediatric dosage forms of drug substances currently available as intravenous dosage forms was recognized. The preferred oral dosage forms were oral liquids and orodispersible tablets. Patient-centered drug administration practices including factors facilitating drug administration both at hospital wards and at home after patient discharge were identified. Among all healthcare professionals, the efficient cooperation in drug prescribing and administration as well as in educating the child’s caregivers in correct administration techniques before discharge and improving the overall discharge process of patients was emphasized. This study complements the prevalent understanding that new dosage forms for children of varying ages and stages of development are still needed. It also brings a holistic view on different aspects of oral drug administration to pediatric patients and overall patient-centered drug administration practices.

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“…A manipulação de medicamentos na pediatria para ajuste de dose individual, incluindo a partição de comprimidos, é algo comum e comprimidos divididos são frequentemente usados na prática clínica para atingir a dose prescrita [6][7][8] . A falta de disponibilidade de variadas formas farmacêuticas de quimioterápicos, utilizados para o tratamento de leucemias agudas de crianças e adolescentes, faz com que esses medicamentos sejam manipulados para atender às demandas pediátricas 9,10 .…”

Section: Introductionunclassified

“…Isso pode ser problemático, considerando que grande parte dos antineoplásicos são citotóxicos e agentes perigosos, podendo causar danos às pessoas que estão envolvidas na preparação, na administração de medicamentos e no cuidado de quem está em quimioterapia 11-14 , já que a partição de comprimidos em um ambiente não controlado as expõe à poeira citotóxica 10 . Além disso, a manipulação também é preocupante por conta de questões que incluem estabilidade, biodisponibilidade e precisão da dosagem do medicamento, podendo ser administradas doses tóxicas ou subterapêuticas para a criança/adolescente 6,8 . Isso se torna mais relevante levando em consideração que os quimioterápicos têm um índice terapêutico estreito, então a administração correta é crucial para que se tenha eficácia e segurança 15 .…”

Section: Introductionunclassified

Partição de Comprimidos Antineoplásicos Utilizados no Tratamento de Leucemias Agudas em Crianças e Adolescentes

Tessmann

Souza

Córdoba

et al. 2020

Rev. Brasileira.De.Cancerologia

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Introdução: A manipulação de antineoplásicos para ajuste de dose, como partição de comprimidos, e comum no tratamento de leucemias agudas de crianças e adolescentes. Objetivo: Identificar a frequência e descrever a pratica da partição domiciliar de comprimidos antineoplásicos utilizados no tratamento oral de crianças e adolescentes com leucemias agudas na fase de manutenção. Método: Trata-se de um estudo transversal descritivo, realizado em um hospital pertencente a rede de saúde publica do Distrito Federal com assistência especializada em pediatria. Foram incluídos no estudo crianças e adolescentes entre 1 e 18 anos, diagnosticados com leucemias agudas e em fase de manutenção do tratamento no período de estudo. Foi aplicado um questionário semiestruturado ao responsável principal pela administração dos medicamentos quimioterápicos via oral, podendo ser o cuidador ou a própria criança/adolescente. Foram coletadas variáveis sociodemográficas dos pacientes e cuidadores e variáveis sobre a pratica de partição de medicamentos antineoplásicos no domicilio. Resultados: Todos os 48 entrevistados no período do estudo relataram ter partido comprimidos antineoplásicos ao longo do tratamento de leucemias agudas, sendo estes mercaptopurina (n=45 [93,75%]) e tioguanina (n=3 [6,25%]). Conclusão: A partição de comprimidos antineoplásicos foi uma pratica unanime em virtude da necessidade referida de ajuste de dose individual para o tratamento de leucemias agudas de crianças e adolescentes, considerando a indisponibilidade de formulações adequadas. Os resultados reforçam a necessidade de a partição ser uniformizada e realizada de maneira a minimizar os riscos e a garantir a segurança para as crianças e adolescentes e seus cuidadores.

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Manipulating tablets and capsules given to hospitalised children in Norway is common practice

Abstract: Manipulation of oral medication was regularly performed on paediatric wards. There is an urgent need for age-appropriate medicines, documented and standardised processes for manipulating medicines and staff training on the consequences of manipulation.

Cited by 42 publications

References 23 publications

Manipulation of oral medication for children by parents and nurses occurs frequently and is often not supported by instructions

Manipulation of oral medication for children by parents and nurses occurs frequently and is often not supported by instructions

A Focus Group Study about Oral Drug Administration Practices at Hospital Wards—Aspects to Consider in Drug Development of Age-Appropriate Formulations for Children

Partição de Comprimidos Antineoplásicos Utilizados no Tratamento de Leucemias Agudas em Crianças e Adolescentes

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