Minimising medication errors in children.

Medical errors are a major problem in the UK and other countries. Apart from the direct expense to the healthcare system, there are great personal costs to those involved including patients, their families and staff, and public confidence is undermined. Therefore, policy initiatives have been implemented to reduce such mistakes. Medication errors are thought to be the most common type of medical errors, with the majority of studies being conducted in adults. However, recent evidence highlights the fact that medication errors are also a significant problem in the paediatric population. This paper reviews the factors contributing to paediatric medication errors, including lack of appropriate paediatric formulations, communication issues between health professionals, dose calculation mistakes and inadequate clinical practice. This review will also discuss risk reduction strategies such as electronic prescribing and computerised physician order entry (CPOE) systems which can significantly reduce paediatric medication errors in conjunction with pharmacist monitoring, improved communication and environments which promote best practice.

Comparison of complementary and alternative medicine use: reasons and motivations between two tertiary children's hospitals.

AIMS: To compare prevalence, reasons, motivations, initiation, perceived helpfulness, and communication of complementary and alternative medicine (CAM) use between two tertiary children's hospitals. METHODOLOGY: A study, using a face-to-face questionnaire, of 500 children attending the University Hospital of Wales, Cardiff, UK was compared to an identical study of 503 children attending the Royal Children's Hospital, Melbourne, Australia. RESULTS: One year CAM use in Cardiff was lower than Melbourne (41% v 51%; OR = 0.67, 95% CI 0.52-0.85), reflected in non-medicinal use (OR = 0.41, 95% CI 0.29-0.58) and general paediatric outpatients (OR = 0.38, 95% CI 0.21-0.67). Compared to Melbourne, factors associated with lower CAM use in Cardiff included families born locally (father: OR = 0.58, 95% CI 0.44-0.77) or non-tertiary educated parents (mother: OR = 0.54, 95% CI 0.38-0.77). Cardiff participants used less vitamin C (OR = 0.31, 95% CI 0.18-0.51) and herbs (OR = 0.49, 95% CI 0.34-0.71), attended less chiropractors (OR = 0.25, 95% CI 0.06-0.37) and naturopaths (OR = 0.08, 95% CI 0.02-0.33), but saw more reflexologists (OR = 3.33, 95% CI 1.08-10.29). In Cardiff, CAM was more popular for relaxation (OR = 1.92, 95% CI 1.03-3.57) but less for colds/coughs (OR = 0.4, 95% CI 0.27-0.73). Most CAM was self-initiated (by parent) in Cardiff and Melbourne (74% v 70%), but Cardiff CAM users perceived it less helpful (OR = 0.46, 95% CI 0.31-0.68). Non-disclosure of CAM use was high in Cardiff and Melbourne (66% v 63%); likewise few doctors/nurses documented recent medicinal CAM use in inpatient notes (0/21 v 2/22). CONCLUSIONS: The differences in CAM use may reflect variation in sociocultural factors influencing reasons, motivations, attitudes, and availability. The regional variation in use and poor communication highlights the importance of local policy development.

Improving drug use for children in the developing world.

Children differ significantly from adults in the way they absorb, metabolise, and excrete drugs. These parameters also vary as children grow from neonates through to adolescence. The practical implications and challenges that this presents are well know to anyone who is involved in the medical management of sick children. The importance of paediatric medication safety and efficacy has been gaining increasing attention in the developed world over the past decade. The United States has introduced a carrot and stick approach to increase research into medications for children with the "paediatric exclusivity provision" and the "paediatric rule". The European Union is also investigating ways of improving the availability of medications for children. Unfortunately, this increased focus on appropriate medicines for children, which has occurred in the developed world, has not been mirrored in developing nations. Currently more than 10 million children under the age of 5 years die each year, with only six countries accounting for 50% of these deaths. The majority of these deaths are from treatable or preventable diseases. The developed world has a moral and ethical obligation to share its gains with the children of the world.

Clonidine poisoning in children: a recent experience.

OBJECTIVES: To identify cases of clonidine poisoning presenting to a tertiary paediatric hospital and to investigate trends in presentation, outcome and prevention. Furthermore, any public health implications of the use of clonidine in children are to be explored. METHODS: Cases of clonidine poisoning presenting to Royal Children's Hospital were reviewed over the period from 1997 to 2001 (inclusive), with significant data obtained from coded medical records. RESULTS: Twenty-four cases of clonidine poisoning were identified over the 5-year period. Nine patients ingested their own medication, which was prescribed for attention-deficit hyperactivity disorder. Clonidine was prescribed for a child in 16 cases (67%). Impaired conscious state and bradycardia were the most common presenting features. Activated charcoal was given in 14 cases and volume expansion in six. There were 12 children (50%) who required admission to intensive care for monitoring, including three who received mechanical ventilation. The average length of stay was 25.7 h with no long-term complications. CONCLUSIONS: This is the largest series of clonidine poisoning in children recorded in Australia, with morbidity considerable. Emphasis needs to be placed on educating parents of clonidine's dangers in overdose to their own children as well as others.

Randomized, controlled trial comparing once daily and three times daily gentamicin in children with urinary tract infections.

OBJECTIVE: To undertake population pharmacokinetic modeling and to determine the safety and efficacy of once daily (OD) gentamicin dosing in children with severe urinary tract infections (UTI). METHODS: An open, randomized, controlled trial comparing OD with three times daily (TD) gentamicin dosing in hospitalized children ages 1 month to 12 years with UTI. Daily doses (milligrams per kg per day) of gentamicin in both groups were 7.5 (<5 years old), 6.0 (5 to 10 years old) and 4.5 (>10 years old). RESULTS: There were 179 children enrolled (90 OD, 89 TD). Baseline clinical characteristics and pathogens were similar, except that circulatory compromise and renal cortical scintigraphic defects were more common in the OD group. Median gentamicin treatment durations were 3.0 (OD) and 2.7 (TD) days. Mean peak gentamicin concentrations were 17.3 (OD) vs. 6.4 (TD) mg/l; 99% of peak concentrations were >7 mg/l in the OD group whereas 16% of peak concentrations were <5 mg/l in the TD group. Mean trough concentrations were 0.35 (OD) vs. 0.55 (TD) mg/l. In the OD group 4% of trough concentrations were > or = 2 mg/l, whereas in the TD group only 0.7% were > or = 2 mg/l. Age or prior elevated peak concentrations did not predict high trough concentrations. Population pharmacokinetic modeling of the data fitted a one-compartment model with first order elimination. There were no clinical or bacteriologic failures. The two disease-related complications were confined to the OD group. No nephro- or ototoxicity was identified. CONCLUSIONS: With age-appropriate dosing and measurement of serum trough concentrations before the second dose, OD gentamicin is safe and effective for the treatment of UTI requiring parenteral treatment in children aged 1 month to 12 years.