‘Working outside the box’—an interview study regarding manipulation of medicines with registered nurses and pharmacists at a Swedish paediatric hospital

Abstract

AimStudies on frequencies of manipulated medicines in paediatric care are common, but there is little knowledge of experiences of pharmacists and registered nurses in this area. The aim of this study was to explore registered nurses' and pharmacists' reasoning in the manipulation of medicines to paediatric inpatients.MethodsSemistructured interviews with twelve registered nurses and seven pharmacists were performed at a Swedish paediatric university hospital. The interviews were transcribed verbatim and analysed using content analysis.ResultsFour major categories emerged from the analysis of the interviews: medicines management, knowledge, consulting others and organisation. Medicines management involved the process of drug handling, which is prescribing, reconstitution or manipulation and administration. Knowledge concerned both the knowledge base and how healthcare personnel seek information. Consulting others involved colleagues, registered nurses and pharmacists, between registered nurses, pharmacists and physicians and between registered nurses, pharmacists and caregivers. Organisation covered documentation, time and working environment.ConclusionBoth pharmacists and registered nurses stated that manipulation of medicines to paediatric patients was often necessary but felt unsafe due to lack of supporting guidelines. Pharmacists were natural members of the ward team, contributing with specific knowledge about medicines and formulations.

Issue highlights

“…Interviews with Swedish paediatric nurses and pharmacists explored how they felt about having to crush and dissolve adult drugs to provide the prescribed doses for children, due to the lack of child‐friendly dosage forms and strengths. Andersson et al 2 . report that the participants felt unsafe carrying out these common procedures, due to the lack of guidelines.…”