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Faults in prescribing for children in NHS hospitals confirms tragic case history |
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16 January 2008 |
A new study supports concerns raised by Kester Cunningham John that doctors too often treat children as 'little adults' instead of patients with their own requirements.
The research is from Newcastle University, and claims that too often doctors are not trained in the types of medicine and the doses appropriate for children.
A new study supports concerns raised by Kester Cunningham John that doctors too often treat children as 'little adults' instead of patients with their own requirements.
The research is from Newcastle University, and claims that too often doctors are not trained in the types of medicine and the doses appropriate for children. It points out that whereas adults have standard doses, for children their doses are calculated on a number of factors: their weight, if they are premature, and how old they are. So each dose has to be worked out on an individual basis for each patient.
The study backs research from the US which suggests that children are three times more liable than adults to an error in their medication.
Kester Cunningham John expressed concerns over the competence of some doctors in prescribing drugs for children following a tragic case in which they acted on behalf of grieving parents from Manchester.
A two month-old baby girl was born with a heart condition which needed surgery. But afterwards she became unwell and distressed, and her parents saw blood flowing back into the tube inserted into her artery and into her feeding tube. She died later that day.
Later it was discovered that the infusion of a drug called Heparin had been incorrectly calculated, so she was receiving it at ten times the appropriate dose. She had effectively bled to death.
The report from Newcastle University suggests that the Department of Health should require every doctor to demonstrate competence before dosing children, because drug formulations are designed for adults and the children's measurement is a proportion of that, and needs an extra calculation. Only three centres in the UK told researchers that they make sure their doctors are competent to prescribe to children.
Trefine Maynard is a partner with Kester Cunningham John and head of the clinical negligence team. She specializes in legal cases involving children, and led concerns at the time of the tragic case above over doctors' qualifications in prescribing for children.
'Before a nurse can give a medicine to a child they have to pass a test, and before a pharmacist can dispense they have to pass a test,' she explains. 'But doctors are allowed to prescribe for adults and children, and the level of training is very variable across the country.
'It's quite common when investigating a legal case involving a child's treatment in the NHS to discover that, when taken to hospital, there was no doctor with experience of treating or prescribing for children.'
The Newcastle research was backed by the school of pharmacy at London University and the Royal College of Paediatrics and Child Health. It involved sending questionnaires to 319 centres in the UK, and discovered that junior doctors get no more than a 30-minute or 60-minute presentation on the issues, although some have workbooks, and some computer-based training and practice questions.
There is very rarely an assessment of understanding and skills, including the mathematical competence to calculate an age-appropriate dose.
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