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      Rational dispensing of oral dosage forms of medicines to children at a teaching hospital in Sri Lanka

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          Abstract

          Background

          Good dispensing practice is vital for rational use of medicines. There are many paediatric specific challenges when maintaining good dispensing practices to children. Lack of age appropriate dosage forms, lack of medicines in strengths suitable for children, lack of palatable medicines, lack of expertise in paediatric pharmacy are few challenges faced when maintaining good dispensing practices to children. These challenges contribute to poor dispensing practices. Hence there is an urgent need to investigate whether oral dosage forms of medicines are dispensed rationally to children. The objective of this study was to describe the rational dispensing practice of oral dosage forms of medicines to children in a Teaching Hospital in Sri Lanka.

          Methods

          A descriptive cross sectional study was conducted to assess the dispensing practice of 1800 oral dosage forms of medicines dispensed to children under the age of 12 years in two outdoor pharmacies over a period of 1 year using validated indicators. Required data were extracted from the prescriptions and by observation using a structured pre-tested observation sheet. Descriptive statistics and wherever relevant, chi square test were used in analysing the data.

          Results

          Information on 1800 oral dosage forms was obtained from 1889 medicines dispensed to 727 children. Liquids were 52% [95% CI: 50–55%] of these oral dosage forms. Of the solid dosage forms, about one quarter required manipulation prior to administration such as splitting and dissolving or crushing the adult dosage form. None of the medicine packs or bottles had the patient name on the label.

          Conclusion

          Dispensing practice of oral dosage forms of medicines to children has room for improvement.

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          Most cited references11

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          Assessment of WHO/INRUD core drug use indicators in two tertiary care hospitals of Bahawalpur, Punjab, Pakistan

          Background Medicines are a main therapeutic intervention provided within hospitals and their proper use in the outpatient setting is important for patients and the community. The objective of this study was to evaluate drug use patterns in the outpatient departments (OPDs) of two tertiary care hospitals (Bahawal Victoria Hospital and Civil Hospital) in the Bahawalpur district of the Punjab province of Pakistan by employing the standard World Health Organization/International Network of Rational Use of Drugs (WHO/INRUD) drug use indicators. Methods A descriptive, cross-sectional study design was employed. For assessing the prescribing indicators a sample of 2400 prescriptions were systematically reviewed out of a total of 1,560,000 prescriptions written from 1st April 2014 to 31st March 2015. A total of 600 randomly selected patients and all pharmacy personnel were observed and interviewed to investigate the patient-care and facility-specific indicators. We used the published ideal standards for each of the WHO/INRUD indicators for comparison purposes. Results Among the prescribing indicators, the average number of drugs per prescription was 2.8 (SD = 1.3), the drugs prescribed by generic name were 56.6 %, the encounters with an antibiotic prescribed were 51.5 %, no injections were prescribed and 98.8 % of the drugs prescribed were from the Essential Drugs List (EDL). Among the patient-care indicators, the average consultation time was 1.2 min (SD = 0.8), the average dispensing time was 8.7 s (SD = 4.9), the percentage of drugs actually dispensed was 97.3 %, the percentage of drugs adequately labeled was 100 % and the patients’ knowledge of correct dosage schedule was 61.6 %. Among the facility-specific indicators, all OPDs had a copy of the EDL and 72.4 % of the key drugs were available in stock. Conclusion Irrational use of drugs was observed in both OPDs. Polypharmacy, brand prescribing, over-prescribing of antibiotics, short consultation and dispensing times, lack of patients’ knowledge about prescribed medicines and unavailability of all key drugs in stock were the major issues that need attention of the healthcare authorities. This study necessitates the requirement to implement the relevant WHO recommended core interventions to promote rational use of medicines in these hospital-based OPDs.
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            "Avoid the crush": hazards of medication administration in patients with dysphagia or a feeding tube.

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              Patterns of prescription and drug dispensing.

              To analyze the patterns of prescriptions and drug dispensing using World Health Organization core drug use indicators and some additional indices. Data were collected prospectively by scrutinizing the prescriptions written by pediatric resident doctors and by interviewing parents of 500 outpatient children. The average number of drugs per encounter was 2.9 and 73.4% drugs were prescribed by generic name. Majority of drugs prescribed were in the form of syrups (60.8%). Use of antibiotics (39.6% of encounters) was frequent, but injection use (0.2% of encounters) was very low. A high number of drugs prescribed (90.3%) conformed to a model list of essential drugs and were dispensed (76.9%) by the hospital pharmacy. Certain drugs (5.7%) prescribed as syrups were not dispensed, although they were available in tablet form. Most parents (80.8%) knew the correct dosages, but only 18.5% of drugs were adequately labeled. No copy of an essential drugs list was available. The availability of key drugs was 85%. Interventions to rectify over prescription of antibiotics and syrup formulations, inadequate labeling of drugs and lack of access to an essential drugs list are necessary to further improve rational drug use in our facility.
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                Author and article information

                Contributors
                abi0108@yahoo.com , abarna@sjp.ac.lk
                docsathiadas@hotmail.com
                sshalini14@hotmail.com
                Journal
                BMC Health Serv Res
                BMC Health Serv Res
                BMC Health Services Research
                BioMed Central (London )
                1472-6963
                6 May 2020
                6 May 2020
                2020
                : 20
                : 377
                Affiliations
                [1 ]GRID grid.267198.3, ISNI 0000 0001 1091 4496, Department of Pharmacy and Pharmaceutical Sciences, Faculty of Allied Health Sciences, , University of Sri Jayewardenepura, ; Nugegoda, Sri Lanka
                [2 ]GRID grid.412985.3, ISNI 0000 0001 0156 4834, Department of Paediatrics, Faculty of Medicine, , University of Jaffna, ; Jaffna, Sri Lanka
                [3 ]GRID grid.8065.b, ISNI 0000000121828067, Department of Pharmacology, Faculty of Medicine, , University of Colombo, ; Colombo, Sri Lanka
                Author information
                http://orcid.org/0000-0001-8009-4737
                Article
                5246
                10.1186/s12913-020-05246-x
                7201638
                32375749
                b2d081ad-2cb0-4d3f-9ade-111f9afc9278
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 4 May 2019
                : 22 April 2020
                Funding
                Funded by: University Grant Commisssion
                Award ID: UGC/DRIC/PG/2015(ii)/SJP/01.
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2020

                Health & Social care
                rational use,oral dosage form ,dispensing,children,indicators
                Health & Social care
                rational use, oral dosage form , dispensing, children, indicators

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