Document resource
Background Antibiotics are the most frequently prescribed medicines in paediatric hospitals, 1 with suspensions preferred for patients unable to swallow solid dose forms.To improve stability, many of these are supplied as lyophilised powder and reconstituted in a pharmacy. However, for prolonged courses, the short shelf-life once prepared may necessitate supply of dry powder for home reconstitution on discharge.Liquid formulations are estimated to be involved in 80% of paediatric home medication errors, with complex administration instructions exacerbating this risk.2 Dry powder antibiotics may be reconstituted incorrectly, administered neat, or improperly stored.3–4 Conversely, delays with alternative supply routes risk missed doses. Despite these challenges, no published guidance exists to support decision-making.Aims Investigate national paediatric hospital pharmacy practices for supplying dry powder antibiotics for home reconstitution, focusing on: availability of standard operating procedures (SOPs), alternative supply routes and factors influencing decision-making, resources used to support parents and patients.Method A survey was distributed to Neonatal & Paediatric Pharmacy Group members.Five-point Likert scales were used to assess both frequency of specific practices and respondents’ support for them. For each question, a Net Promoter Score (NPS) was calculated, with scores ranging from –100 (least frequent or supported) to 100 (most frequent or supported).Descriptive statistical analysis was conducted using Microsoft Excel.Results 58 responses were received from 45 organisations, with 31% (14/45) indicating the availability of a local SOP. 50% of respondents reported often or always supplying dry powder antibiotics if circumstances required it (NPS = 33). Alternative supply routes were less common, with outpatients (NPS = -31) more frequent than primary care, delayed collection, or urgent care (NPS = -48, -55 and -79 respectively). Prescription amendments to alternative preparations were reported to occur rarely, if ever, by 82% of respondents (NPS = -79).Parental/patient competency was the strongest factor (NPS = 74) influencing supply decisions, followed by course length (NPS = 50) and professional discretion (NPS = 38). Supplementary labelling was often or always used to support with reconstitution (87%), storage (84%), and expiry dates (74%), and was widely regarded as useful (NPS = 66, 68 and 70 respectively). Conversely, 64% reported rarely or never supplying marked syringes or dosing cups for measuring diluent; this was reflected by low perceived value (NPS = -32 and -35 respectively).Pharmacy-led counselling was often or always employed (66%), and highly valued (NPS = 87). Despite patient information leaflets (PILs) being viewed as helpful (NPS = 58 and 62 for local and national leaflets, respectively), 53% reported rarely or never providing them.Conclusion Hospital practices for supplying dry powder antibiotics for home reconstitution vary widely and are largely unsupported by SOPs. This identifies a need for good practice guidance to promote consistency and minimise risks. Such guidance should include standards for labelling, counselling or assessing parental/patient competency as these were common, valued interventions. Furthermore, there is a clear requirement for a standardised, accessible PIL.As this survey reflects only healthcare professionals’ views, subsequent research must explore parental/patient preferences to inform future recommendations.References Versporten A, Bielicki J, Drapier N, et al. The worldwide antibiotic resistance and prescribing in european children (arpec) point prevalence survey: developing hospital-quality indicators of antibiotic prescribing for children. Journal of Antimicrobial Chemotherapy 2016;71:1106–1117.Shonna YH, Neuspiel DR, Paul IM, et al. Preventing home medication administration errors. Pediatrics 2021;148(6):e202105666.Aika IN, Enato, E. Bridging the gap in knowledge and use of antibiotics among pediatric caregivers: comparing two educational interventions. Journal of Pharmaceutical Policy and Practice 2023;16(1):76.Institute of Safe Medication Practices. Ensure medications are properly reconstituted to prevent dosing errors and patient harm. Pharmacy Today 2024;30(5):31.