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Challenges of safe medication practice in paediatric care: A nursing perspective
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
Uppsala Monitoring Centre, WHO Collaborating Centre for International Drug Monitoring.
2013 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 102, no 5, 532-538 p.Article in journal (Refereed) Published
Abstract [en]


To explore nurses' experiences of handling medications in paediatric clinical practice, with a focus on factors that hinder and facilitate safe medication practices.


Twenty nurses (registered nurses) from four paediatric wards at two hospitals in Sweden were interviewed in focus groups. The interviews were analysed using content analysis.


Six themes emerged from the analysed interviews: the complexity specific for nurses working on paediatric wards are hindrances to safe medication practices; nurses concerns about medication errors causes a considerable psychological burden; the individual nurse works hard for safe medication practices and values support from other nurse colleagues; circumstances out of the ordinary are perceived as critical challenges for maintaining patient safety; nurses value clear instructions, guidelines and routines but these are often missing, variable or changeable; management, other medical professionals, the pharmacy, the pharmaceutical industry and informatics support need to respond to the requirements of the nurses working situations to improve safe medication practices.


Weaknesses were apparent in the long chain of the medication delivery process. A joint effort by different professions involved in that delivery process, and a nationwide collaboration between hospitals is recommended to increase safe medication practices in paediatric care.

Place, publisher, year, edition, pages
2013. Vol. 102, no 5, 532-538 p.
Keyword [en]
medication errors, paediatric nurses, safe medication practice
National Category
Medical and Health Sciences
Research subject
Caring Sciences
URN: urn:nbn:se:uu:diva-197329DOI: 10.1111/apa.12212ISI: 000317361400030PubMedID: 23432129OAI: oai:DiVA.org:uu-197329DiVA: diva2:612569
Available from: 2013-03-22 Created: 2013-03-22 Last updated: 2013-08-30Bibliographically approved
In thesis
1. Safety of Medication in Paediatrics
Open this publication in new window or tab >>Safety of Medication in Paediatrics
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: In paediatrics, the limited documentation to guide medication, the lack of suitable dosage forms, and the continuous development in childhood present a scenario where safety of medication is a particular challenge.

Aim: To explore reported adverse drug reactions (ADRs) and the challenges in prescribing and administering medicines in paediatrics, in order to identify and suggest areas needing international surveillance within medication safety and improvement in the clinical setting.

Methods: Four exploratory studies were conducted. Worldwide reporting of suspected ADRs (individual case safety reports, ICSR) with ages 0-17 years were examined overall. Twenty published case reports and ICSRs for adolescents, who developed a rare and incompletely documented ADR (rhabdomyolysis) during antipsychotic medicine use, were analysed in-depth. Prescribed doses of anti-inflammatory medicines were studied in a UK electronic health record database. Transcribed focus group interviews with 20 registered nurses from four paediatric wards in Sweden were analysed for factors that may promote or hinder safe medication practices. Descriptive statistics, multiple regression, and content analyses were used.

Results: Although, skin reactions and anti-infective medicines were most frequently reported, and more reported in paediatric patients than in adults, medication errors and adverse reactions related to psychostimulant medicines were reported with increased frequency during 2005 to February 2010. The in-depth case analysis emphasised the need for increased vigilance following changes in patients’ medicine regimens, and indicated that ICSRs could contribute with clinically valuable information. Prescribed dose variations were associated with type of dosage form. Tablets and capsules were prescribed with a higher dose than liquid dosage forms. Six themes emerged from the interviews: preparation and administration was complex; medication errors caused considerable psychological burden; support from nurse colleagues was highly valued; unfamiliar medication was challenging; clear dose instructions were important; nurses handling medications needed to be accorded higher priority.

Conclusions: Age-specific screening of ICSRs and the use of ICSRs to enhance knowledge of ADRs and medication errors need to be developed. Access to age-appropriate dosage forms is important when prescribing medicines to children. To improve medication safety practices in paediatric care, interdisciplinary collaborations across hospitals on national or even global levels are needed.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2013. 81 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 883
paediatrics, adverse drug reaction, drug-related problem, medication error, patient safety, individual case safety reports, pharmacovigilance, medication, nurses, health care personnel, dosage form, NSAID, dosing, prescription, antipsychotic medicines, postmarketing surveillance
National Category
Medical and Health Sciences
Research subject
Medical Science
urn:nbn:se:uu:diva-197323 (URN)978-91-554-8632-7 (ISBN)
Public defence
2013-05-16, Gustavianum Auditorium Minus, Akademigatan 3, Uppsala, 09:15 (English)
Available from: 2013-04-24 Created: 2013-03-22 Last updated: 2013-08-30Bibliographically approved

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