Transcript Paediatric Prescribing

Paediatric Prescribing
Suzy Heafield
Pharmacy Department at QMC
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Where? Paediatric satellite (Outpatients at weekends)
All paediatric wards have a visit by a clinical
pharmacist (bleep numbers on ward)
Look at completeness & accuracy of prescription and
monitor for contraindications, correct dosing, side
effects & interactions
Hours – 0900 to 1700 Monday to Friday (on-call
pharmacist available for whole hospital outside these
times)
On-call
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No TTOs after 6pm except Short Stay Unit and
Oncology ward attenders
No TTOs after midnight
Nurse dispensing on SSU for paracetamol, ibuprofen,
salbutamol and dioralyte (will include other items soon)
Always available for advice!
If starting new medication after 8pm Dr must contact
pharmacist (only if urgent)
No pharmacist on site after midnight
Pharmacy Department (2)
Other areas of pharmacy:
 Medicines information
 Sterile production unit – TPN,
CIVAS,chemotherapy
 Non-sterile manufacturing unit can make some
products not available commercially
NUH Guidelines
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Medicines code of practice
IV guide – yellow pages. Currently being
reprinted
Paediatric policies
Paediatric Formularies
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If no policy:
Don’t use adult BNF!
C-BNF is first line reference source - available
on all paed wards. (Paed policy doses may
differ from C-BNF – e.g. ceftriaxone)
Medicines for Children may contain some
drugs not in C-BNF
Dangerous Medicines
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Aminoglycosides – monitoring!
Aminophylline
Amiodarone
Cytotoxic drugs – SHOs do not prescribe
Digoxin
Insulin
Morphine & other opiates
Phenytoin
Potassium - NPSA
Good Prescribing Guidelines
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Always write in black indelible ink
Always write in block capitals – must be legible
Doses are prescribed using only “g”(grams),
“mg”(milligrams), micrograms(in full), units(in full)
Write in dose you are using expressed as per kg
Carry forward original starting date when re-writing
charts
If possible prescribe drugs on a single chart. If not,
number charts and tie together
Good Prescribing Guidelines
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Always rewrite a prescription when dose or
timing altered
Always use a calculator
Always refer to the drug administration manual,
policy file or hospital codes of practice
Don’t rush – take your time & check your
calculation
Use rINNs
Drug Chart
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Essential:
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Name / DOB / Hospital number
Correct weight
Allergy box – must be signed before a drug can be
administered
TTOs
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Write number of days required, particularly
antibiotics and steroids
Use dose-banding guidelines for paracetamol
and ibuprofen – parents find it difficult to
measure 6.32ml!
Prescribe as early as possible – ideally 24
hours before discharge
Any questions?