Dr. Mary Ann Kliethermes
Director of Medication safety and Quality, American Society of Health-System Pharmacists (ASHP)
An estimated 10 to 30 percent of adverse medication events occur among children, Dr. Mary Ann Kliethermes, director of medication safety and quality at the American Society of Health-System Pharmacists (ASHP) explained.
Because it is difficult to complete the requirements necessary for the U.S. Food and Drug Administration (FDA) to approve medications in children, many treatments commonly used in children have been studied but not formally approved. The result is doctors, nurses and pharmacists caring for patients must adapt medications made for adults for use in children.
There are numerous reasons administering a medication meant for an adult to a youngster can be dangerous, Kliethermes said. For example, when tablets and capsules are formulated for an adult body, they need to be compounded into liquids to meet a dose correct for a child or one they can swallow. How the medication is compounded can differ between pharmacies both in the hospital and the community. This may lead to confusion on dosing instructions that may result in a child receiving a medication that is too weak or too strong than was intended. ASHP is working to set standards for liquid medication concentration in hopes that the healthcare industry would follow these guidelines across the board. “If we, as a nation and as an industry, use these standards, especially in high-cost, high-risk drugs, with standard concentrations, then we can greatly reduce errors that are occurring in dosing,” Kliethermes said.
In addition, it is not always the medication but the inactive ingredients used to formulate the dosage form of the medication. For one, drugs meant for adults may contain alcohols that have the potential to suppress the respiratory system in a small body. What’s more, some medications have parabens used as a preservative, which can cause certain drugs to be more toxic in children. Even an ingredient as simple as added sugar may lead to diarrhea and cramping when given as an adult dose to a child.
In the immediate future, healthcare professionals can do their part to promote pediatric medication safety by investing in helpful technology, Kliethermes suggested. One option is computerized provider order entry (CPOE), which provides upper and lower thresholds for safe prescription dosing. Another tool is just emerging called clinical decision support (CDS) hooks, which uses artificial intelligence (AI) to consider dosing standards and the patient’s unique health information to make recommendations, Kliethermes said.
Standardization in formulary and concentration are also crucial, as is taking a team-based approach to care, Kliethermes said. “So, there is a member of the health care team that has the responsibility to make sure the medication is correct.”
Healthcare providers can also help ensure their patients are retaining the medication instructions that they receive. One way to do this is by using a teach-and-show-back approach, Kliethermes said. “What we do is say, ‘I want to make sure that you understood what I said. Can you tell me how you’re going to do this? How are you going to give this dose to this child?’” she explained.
This way, Kliethermes added, parents and family “can be your second eyes and second ears to make sure that there are no problems.”