Objective The use of unlicensed and off-label drugs for administration to children and neonates is well established and this necessitates the manipulation of some drugs at the point of administration with the purpose of achieving dose accuracy.1 2 The MODRIC (manipulation of drugs required in children) study aims to establish the nature of current clinical practice and the available evidence with regard to this practice.

Methods A systematic review using a broad mapping review approach to identify and assess all the available evidence. Drug manipulations were identified through a quantitative review of all the prescribed medications through a 5-day period in clinical practice in inpatient care in a large regional paediatric hospital, a district general hospital and a large regional neonatal unit.

Results The systematic review has established that there is a paucity of evidence on drug manipulation for tablets, a lack of evidence for other dosage forms and that the evidence available is equivocal. Review of the prescribed medications over a 5-day consecutive period identified that although drug manipulations for dose accuracy were most frequently required with tablets they occurred across many dosage forms and involved routinely prescribed neonatal and paediatric drugs. This review also identified that for approximately 10% of all prescribed drugs either a drug manipulation for dose accuracy was required or a measurement of a volume of less than 0.2 ml would be needed if a manipulation was not used.

Conclusion Initial results have shown that drug manipulations for dose accuracy are required frequently in neonatal and paediatric inpatient settings. However there is insufficient evidence to support this practice. Using these results and additional data from clinical practice, the MODRIC study will undertake a risk assessment and develop a guidance document on drug manipulation for dose accuracy.