Fundamentals of Pharmacology for Children's Nurses. Группа авторов

although some shops have their own age limits for sales. GPs and nurses will not prescribe over the counter medications, such as paracetamol, for minor illnesses for a child or adult when they can be bought readily and at a cheaper cost to the individual and NHS, although there is a list of exemptions. The cost of prescribing over the counter medications to the NHS is approximately £136 million per year (NHS, 2018).

      Pharmacy medications are also known as restricted medicines and are a small group of medicines that a pharmacist can prescribe without the patient seeing a doctor or a nurse.

      Prescription‐only medicines are prescribed by a GP, nurse, dentist, midwife or a doctor working in environments other than general practice. The medications on this list are considered to be needed to be used under the supervision of a licensed healthcare practitioner due to the potential to cause harm. There are also many medicines that are used but are not licensed for CYP and these can only be prescribed by a paediatrician or hospital‐based doctor. In comparison to general sales and pharmacy medications, prescription‐only medicines are prescribed for an individual after assessment and the dose is calculated on the child or young person’s height and weight or surface area rather than a standard dose that is more often found with adults.

      Controlled drugs are a group of medicines that can be abused and cause dependence and therefore they are controlled and regulated by the government. The term ‘control’ covers how and where the medicine is made, how it is used, the way that it is handled and stored as well as how it is distributed. In a hospital environment, GP surgery or community care environment such as a hospice or children’s unit, controlled drugs are stored in a metal locked cupboard inside another locked cupboard on a wall, usually in a specific room where medicines are checked and prepared. Access to the keys to the cupboards is limited and controlled. The stock levels of controlled drugs are checked daily by two people and new supplies are also often checked by two people and everything is recorded in a specific logbook (sometimes known as the controlled drugs register) according to local policy and procedure. When preparing a controlled medication to administer to a patient the stock level is checked against the logbook and the details of the patient including the dose, date and time are recorded and signed by two members of staff. The types of controlled substances most often used include opioids (morphine, diamorphine), sedatives (diazepam, temazepam), stimulants (amphetamines used in attention deficit hyperactive disorder), central nervous system depressants (diazepam), hallucinogens and anabolic steroids (testosterone).

Medicine Management

      Medicine management involves the safe storage, management and administration of medications, which includes following local and national policies and guidelines for the safe administration of medication. Monitoring the effectiveness of any medication given, as well as understanding the side effects and contraindications, and being able to explain these to CYP and their family is part of the advancing role in healthcare. The ‘Professional Guidance on the Administration of Medicines in Healthcare Settings’ (RPS and RCN, 2019) outlines professional accountability and covers these aspects in more detail. This document is essential reading for all healthcare staff involved in medicine management and administration. Healthcare students and healthcare professionals are involved in medicine management in a variety of settings and should refer to the Standards of Proficiency for Pre‐registration Nursing Education for Guidance (NMC, 2018b) as well ensuring they are familiar with and abiding to local policy and procedure.

The Standards of Proficiency for Nursing Associates along with the Standards for Pre‐registration Nursing Associate Programmes (NMC, 2018c, 2018d) provide details regarding the preparation of nursing associates and the proficiencies that have to be met prior to the nursing associate’s name being entered on the professional register. The nursing associate (as is the case for the registered nurse) must be able, at the point of registration, to demonstrate and apply knowledge of pharmacology when delivering care. There is also a need to understand the principles of safe and effective administration and optimisation of medicines. Importantly, this must be done in accordance with local and national policies. Procedural competencies (very much related to local policy) must be demonstrated concerning the safe administration of medicines.

Safety: Rights of Medication Administration

      Safety elements when administering medication include the 5 Rights, more commonly known as the 5 Rs (NMC, 2007):

       Right patient

       Right medication

       Right dose

       Right time

       Right route.

      Working within these 5 principles whilst preparing medications and again at the bedside ensures a safe process. As more confidence is amassed in medicine management these principles can be expanded. Elliott and Liu (2010) believe that you should also include giving the medication for the ‘right reason’ and ensure that the ‘right documentation’ is completed correctly. As more understanding of the reasons for errors in medication management are understood, a further 5 rights can be added to the list, culminating in 10 rights, which include the original 5 Rs listed earlier as well as the following five (Edwards and Axe, 2015):

       The right to refuse (know what to do if the patient refuses)

       Right knowledge and understanding (of the drug and patient)

       Right questions (if there is any doubt with the process)

       Right response (monitor the effectiveness of the medication

       Right advice.

      Chapter 4 of this text discusses medicines management and the role of the healthcare provider working with CYP and families in detail.

Specific Considerations for Babies, Children and Young People

      When caring for CYP there are many aspects of medicine administration that need to be given special consideration, including the age of the child, gaining consent, if they have the ability to swallow tablets, the taste of medicines and what to do if a child refuses to take it. Consent will be explored in more depth in Chapter 3.

      The changes in body proportions and composition in CYP change rapidly and this affects the efficacy, toxicity and dosage of medicines for children. Proportions of body fat, protein and extracellular water change over months in newborn babies, whereas at the age of 1 to 2, metabolism and elimination of medications from the liver and kidneys is at its greatest (NICE, 2021). Development of the gastrointestinal tract also affects the absorption of oral medications, and difficulties with this may indicate an intravenous route being more appropriate.

Infancy

Babies are unable to communicate their needs and feelings and assessment of a baby through body language and vital signs is important. The first 12 months of life involve rapid stages of development, from milk feeds through weaning to tolerating solid food as one example. Taste is developing and unusual tastes or textures can often be spat out or refused. It has been recommended that new foods should be introduced to babies four times before giving up, but this might not be possible with medicines. In babies and young children who cannot swallow tablets, liquid medicines or syrups are prescribed. Some liquid medicines/syrups do not have a palatable taste, antibiotics being the most common. Flucloxacillin is an example of a syrup that has a very bitter taste and is not palatable to many. Baguley et al. (2012) recommend not prescribing such medications without first allowing the child to taste it. If a child will not comply with taking the medication, this increases the stress for the parent(s)/carers in encouraging the child to take the medication. It also increases the risk of non‐concordance; the infection or condition not being treated appropriately and the development of drug resistance for the child. If a child is refusing to take liquid medicine due to the taste, further discussion