Figure 78.1 Medication procedure The administration of medicines to children and young people is a complex procedure, not least because of the intricate weight related calculations, frequent inability of the patient to identify or advocate for him/herself and the widespread use of unlicensed medications in this patient group. Therefore, the caution issued by the Nursing and Midwifery Council (NMC 2010) that medication administration is not purely a mechanistic act but one that demands thought and professional judgement, is particularly salutary in this patient group. Although the use of medications that are not licensed for use in neonates, children and young people has traditionally been common, this practice has recently been deemed unacceptable (Department of Health 2012). Work is currently underway to work with the pharmaceutical industry to develop medicines that are safe and suitable for administration to neonates, children and young people. The admission process for children and young people should assess and record details of the child or young person’s prescribed medication, together with their preferences for when this is usually taken and how all medications are usually given (e.g. tablet, syrup, spoon, syringe). Many children’s hospitals operate parent administration procedures that maintain home routine, facilitate integrated family and health care partnership working and help to protect against medication errors (Crawford 2012). The role of the children’s nurse in this process is to provide support to families but remain mindful of the NMC (2010) requirement to ascertain that medication has been administered as recorded. Medications dispensed by hospital pharmacies for discharge frequently do not include guidance on usage. NICE (2009) estimate that 33–50% of all patients with long-term conditions do not take medication as directed, potentially at a cost of over £100 million per year. As children and young people are reliant upon parental understanding of medicine regimes for their well-being, they are particularly vulnerable. The children’s nurse therefore has a key role in explaining rationale for dose, frequency, specific instructions and adverse effects of medication to children, young people and their parents and carers. Where hospital leaflets are unavailable, www.medicinesforchildren.org.uk is a valuable resource. Medication error was the most frequently reported adverse incident reported during an NPSA (2009) patient safety review. Ten per cent of errors affected the 0–4 year age group. The most common error was incorrect dose, followed by omitted doses and incorrect frequency. The Report of the Children and Young People’s Health Outcomes Framework (2012) states that the actual number of incidents and the harm they cause is unknown as reporting is not yet mandatory. There are plans to change this position from April 2013. It is widely acknowledged that although these events are preventable, health care providers will never achieve a position of zero medication incidents (Chang and Mark 2011). What is important is that children’s nursing learns from these events and as advocated by the Children and Young People’s Health Outcomes Forum (2012), initiate bundles of interventions to reduce their frequency.
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Administering medication
Contemporary issues
Involving the child, young person and family
Medicines safety
Calculation formula
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