Medicines for Children Paediatric Palliative Care For Home Based Carers Funded by British High...

Medicines for Children

Paediatric Palliative Care

For Home Based Carers

Funded by

British High Commission, Pretoria

Small Grant Scheme

Children with HIV

Need to prevent infections

Need to treat infections

Need to manage symptoms

May need to manage side effects of drugs

So, they usually need lots of medicines

Types of Medicines

Preventing Infections Bactrim, Vitamins, Immunisations, ARVs

Treatment for infections Antibiotics, Antifungals

Symptom Management Analgesia, Anti-pyretics,

Anti-diarrhoeals, Anti-emetics,

Management of Side Effects Antihistamine, Anti-diarrhoeals,

Anti-emetics

Other Types of Medicine

Home Remedies ?

Traditional Medicines ?

Herbal Remedies ?

©TALC

Medicine Chain

Prescription Certain medicines can be prescribed by Doctor only Some Professional nurses may prescribe with special training

Dispensing Prescription is prepared by a pharmacist Ensures correct drugs, dosage and timing of doses is in a

labelled container for patient

Administering Professional nurses may administer drugs to patient Care givers may only do this under supervision of Professional

Nurse

Scope of Practice

Your scope of practice means you will not usually be

administering pharmaceutical medicines, but you have a vital role!

Children MUST get the medicines they are prescribed If they don’t they can’t work!

Check the child has access to and is getting the drugs

Assess whether carer knows how to give them correctly

Refer any concerns to the Professional Nurse

Ensure any side effects are reported immediately

Reinforce the importance of completing the course to the carer

Support the carer in giving the medicines

Caution

Medicines which are not used correctly can be dangerous

The sale, prescription and dispensing of medicines is controlled by law

All medicines which are sold to the public must be tested and registered with the Medicines Control Council

Medicines Control Council

Schedule 1 and 2 Aspirin, Vitamins, Milk of Magnesia Can be bought at supermarkets and cafes

Schedule 3 Can only be bought by an adult from a pharmacy

Schedule 4 Can only be obtained on the prescription of a doctor from a

pharmacy

Schedule 5,6 and 7 Must be prescribed by a doctor, dispensed by a pharmacist and

prescription renewed every time

(Department of Health, 1997)

Side Effects

Be aware of the more common side effects of medicines

You need to be able to:

Recognise them if a child experiences them

Refer the child for appropriate management

Teach the carer about common side effects of the medicines

Teach her when to seek advice

Ensure the side effects have been managed appropriately

Refer again if they have not

Expiry Date

Medicines are all marked with a date

They MUST be used before that time or they may be harmful or of no use

04Jul06

Adherence

If the medicines are to work, they must be taken

All medicines must be taken in exactly the way they have been

prescribed

This is known as adherence

You have a vital role in assessing: Assessing whether the child is adherent to the medication Identifying any causes of non-adherence Supporting the carer Referring any concerns

Causes of Non-adherence

A child is dependent on the carer. If the carer:

Does not understand the importance of the medicines Does not know which medicines to give to the child and when Does not know how to give the medicines to the child Is unable to remember to give the medicines Does not believe the child should have them Is unable to collect the medicines Is unable to get the child to take the medicines Thinks the child is better now so stops the medicines

The child may be non-adherent!

5 Golden Rules

The right patient The right medicine The right dose The right route The right time

These apply to everybody but…

They are even more important

when giving medicines to children!

(Department of Health, 1997)

The Right Patient

The only person who should receive the medicines prescribed by the doctor, dispensed by the pharmacist and

administered by the professional nurse is

the child whose name is on the bottle/box/bag

The right medicine

If the wrong medicine is given to a child, this could also be very

dangerous

The wrong medicine may not treat or prevent infection, manage

symptoms or side effects

Some medicines should not be given to children

The child may be allergic to that drug

The Right Dose

Children are much smaller than adults

Their bodies have different ways of coping with medicines

Drug doses are extremely carefully calculated for children so:

Drugs achieve their aim but do not harm the child

Doses are calculated by weight (and sometimes height)

Children grow quickly so need regular monitoring of weight

The Dose You MUST give an accurate dose!

NEVER guess the amount to give

NEVER just pour syrup in to the child’s mouth

This could be dangerous for the child:

- He may get too much medicine

- He may get too little medicine

Measuring The Right Dose

Different methods may be used to measure accurate doses of syrups or liquids before giving them to the child

Droppers Marked Medicine Cap Medicine Cup Syringe Spoon

The Right Route

Medicines must always be given by the correct route

Medicines may be administered in the following ways:

By mouth Under the tongue On the skin In to the eye Into the nose In to the rectum By injection By inhalation

The Right Route

The route by which drugs are given to children is extremely

important

Children do not like medicines

May cause trauma and distress to both the child and the carer

If the child cannot/will not take the medicines, they cannot work

The way medicines are given can have a great impact on a child’s quality of life

Medicines By Mouth

Most medicines given to a child

will normally be given by mouth

They come in the form of:

Pills and tablets Capsules Suspensions/mixtures Syrup Drops

Helping the Child Take Medicine

If the medicines are to work, the child must be able to swallow them

A child may have been dispensed medicine that he cannot swallow

This causes unnecessary distress for the child and the carer

The child will not get the medicines he needs

Giving Medicines to a Child

If the medicines are to work, the child needs you to make regular

assessments

Does he like the taste of the medicine?

Is he able to swallow the tablets?

Can he tolerate the volume of syrup?

Giving the Medicine Medicine Cups

Syringes (1ml, 2.5ml, 5ml, 10ml)

Spoon

Plastic dropper©TALC

Giving the Medicine

Need to prevent aspiration

Hold child in semi-reclining position

Place medicine in spoon, plastic cup, plastic dropper, plastic syringe (without needle!)

Place medicine along side of infant’s tongue

Administer slowly

Wait for child to swallow

Handy Hints!

Some medicines are only available as tablets orcapsules

Handy Hints for Children!

Crush tablet if possible/allowed

Mix with jam, porridge

Divide tablet if scored

Empty capsule and sprinkle contents on jam(only allowed for some drugs!)

Handy Hints!

Talking with the Child

Taking Medicines Together

Sticker Charts

Play Therapy

Nasogastric Administration Oral medications may be given

via NG tube

Removes distress of giving medicines

Does not disturb the child

Medicines in liquid form or safe to crush only

Risk of clogging the tube

Always flush tube with clean water

Rectal Administration

Useful for children unable to take anything by mouth

Sedatives, analgesia, anti-pyretic, anti-emetics, anti-convulsants

Often absorbed more quickly and quicker response

Faeces may delay absorption

Unsuitable for child with diarrhoea

Eyes, Ears & Nose Not usually painful but drugs can cause unpleasant sensation

Usually distressing for a child

Difficult for carer to gain child’s cooperation

Infant and young child need to immobilise head

Older child needs explanation and direction

The Right TimeMedicines must be given at the right time or they will not be

effective

Medicines may be ordered

4 hourly (06h00, 10h00, 14h00, 18h00, 22h00) 6 hourly (06h00, 12h00, 18h00, 24h00) Daily (in the morning, after breakfast) Every evening (at bed time) Three times a day (usually after meals) Twice a day (after breakfast and supper)

Medicines must never be given more often than prescribed as thiscould be dangerous for the child

The Right Time

Note! Some drugs must be taken on an empty stomach or with food

These instructions MUST be adhered to

Otherwise the drugs will not work or may be harmful to the child

The importance of this must be explained to the carer

This can cause difficulties for carers when children want to eat / do not want to eat

Summary

Working within your scope of practice, you are not usually involved in administering of medicine

But

You have a vital role in ensuring the children are receiving their medicine, safely and accurately and

that any problems are referred