Introduction Infants and children with congenital heart defects are reliant on medicines to treat the symptoms of heart failure whilst they wait for corrective or palliative surgery. Medicines optimisation for this group of patients is a complex and challenging concept. This is because there are many factors that need to be considered to ensure the effective and safe use of these medicines.

Infants and children undergo significant physiological and pharmacological changes over a relatively short period of time.¹ In addition, this group of patients also present challenges for the safe administration of these medicines at home.² Failure to optimise these medicines may result in reduced symptom control with negative effects on health outcomes for the family and child.

The aim of this service evaluation was to identify whether patients attending for day case diagnostic catheter procedures on the children’s cardiology ward could benefit from having their medicines optimised during their hospital visit.

Method Data was collected prospectively over a period of 7 months from August 2019 to March 2020. Patients were included if they attended the children’s cardiology ward for a day case diagnostic cardiac catheter during the study period. In addition, they needed to be taking at least one long-term medicine at home.

A pharmacist with experience in children’s medicines conducted a medication review with the family during their attendance. This included a consultation about which medicines were being taken at home, and listening to the experience that the family had from using their medicines. Medicines were then reviewed using up to date information such as weight, test results and medicines information resources. Anonymous data was kept using a Microsoft Excel® spreadsheet.

Results In total, 175 patients were assessed for inclusion during the study period. 57 families were found to be administering a long-term medicine at home and had their medicines reviewed. Subsequently, 13 patients had their medicines optimised.

The most common recommendation was to increase the dose of a medicine for an up to date weight or because of failure to control symptoms (n=11). This was frequently seen with medicines such as aspirin, captopril and diuretics.

In addition, more subtle and unexpected interventions regarding medication safety at home were also identified (n=2). For example, one family were found to be ten times under dosing their child due to an unidentified change in strength of liquid medication from primary care. Another family described their difficulty with crushing and dispersing tablets to administer using a nasogastric tube. This resulted in a block tube that required an additional hospital visit to have a new tube inserted. Additional action was taken to report and rectify these medication errors.

Conclusion This project has demonstrated the value that can be gained from a pharmacist providing ongoing reviews of medicines used by families when they attend a children’s cardiology centre. Day case admissions in a specialist hospital may be seen as low priority to professionals. However, this is an ideal opportunity to provide support to families who use medicines at home.

References

1. Kearns GL, Abdel-Rahman SM, Alander SW, et al. Developmental pharmacology--drug disposition, action, and therapy in infants and children. New England Journal of Medicine 2003;349:1157-1167.

2. NHS England and NHS Improvement. The NHS patient safety strategy. Safer culture, safer systems, safer patients. 2019. [Cited: 14th August 2021]. Available at: https://www.england.nhs.uk/patient-safety/the-nhs-patient-safety-strategy/