Challenges in Paediatric Prescribing
Paediatric prescribing differs from adult prescribing due to variations in developmental stages, dose calculations, and drug metabolism. The dynamic anatomy and physiology of children require precise dosing adjustments, making it crucial to develop accurate drug catalogues and order sentences for paediatric patients. Additionally, the coexistence of mixed adult and paediatric populations in many hospitals presents unique challenges that necessitate proper identity management and separate formularies for children.
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Presentation Transcript
Whats different about paediatric prescribing
Children are just small adults Children are just small adults
Vary in their developmental stages Pre-term, neonates, infants, children, adolescents Dynamic anatomy and physiology Including significant changes in weight and surface area Differ in ability to metabolise drugs Cytochrome p450 enzymes not well developed in premature neonates
More dose calculations are required Doses vary depending on age and weight Doses also vary by indications Wide range of correct doses depending on indication Medicines more commonly used outside licence with lack of clear dosage guidance
System must have near perfect identity management
Many hospitals have mixed adult and paediatric populations Not just paediatricians who prescribe Particular issues with adult surgeons who also operate on children Separate Paediatric formulary or order sets
What is the best way to build paediatric drug catalogue and order sentences Options Integrate with adult orders Separate paediatric orders
Age and weight based calculations Dose calculators often crude and work out doses that are too precise Need to take indication into account Can create order sentences based on age and or weight or post-menstrual age for premature babies
Not just prescribing systems but also medicines administration Prescribing doses that can be administered safely By nurses and caregivers Prescribe drugs to be administered at child friendly times Orders to include correct diluents and administration instructions
Most systems do not generate easily administered doses Rounding tolerances depend on age of child and indication This is an area of significant interest now STEPStool project in US trying to come up with rounding parameters for certain medications
Knowledge of childs precise weight essential Validate weights outside normal ranges for age Caution due to variation in development Interaction management may be different in premature neonates vs adolescents Develop indication specific order sets to make relevant orders more accessible to clinicians Round doses to an amount that can be administered
