Prevalence Of Drug Manipulation To Obtain Prescribed Dose In The Paediatric In-Patient Units In Kenyatta National Hospital

Abstract

Background xiv Manipulation of drug dosage forms is frequently conducted in children due to lack of age appropriate formulations. Manipulation involves physical alteration of a dosage form to extract a proportion of the drug amount such as tablet splitting, opening a capsule or splitting a suppository to either obtain prescribed dose or make administration easier. In the United Kingdom, a resource rich setting, frequency of manipulation was 6.5% of drugs administered to children. Kenyatta National Hospital, a national referral hospital is a resource constrained setting. The study aimed at determining the prevalence of manipulation of drugs to obtain the prescribed dose in paediatric in-patient units in this hospital. Method An observational cross sectional study was conducted between 5th and 18th July 2016 in 4 general paediatric wards, oncology patients, specialized surgical ward, paediatric intensive care and newborn units. Medicines administration by nursing staff and clinicians to newly admitted children below 6 years of age was observed. This was to determine the frequency of drug manipulation. Informed consent was obtained from nursing staff and clinicians before observation. Collected data was recorded on drug manipulation observation form. Data was analyzed using chisquare test and independent samples t-test to determine association between the dependent and independent variables. Logistic regression was used to determine factors associated with drug manipulation. Findings 249 medicines administrations were observed. Prevalence of drug manipulation to obtain the prescribed dose was 6.4%. Drug manipulation was frequently conducted in newborn unit (43.8%, p <0.01). A drug’s dosage form is significantly associated with occurrence of drug manipulation (56%, p< 0.0001). Folic acid 5mg tablet was commonly manipulated (31.3%). Manipulation involved tablet segmentation and dispersion (56%) and measurement of intravenous liquid volumes <0.2ml (44%). A drug’s schedule (p = 0.015, OR = 1.195, 95%CI 1.035 - 1.379) was significantly associated with increasing odds of occurrence of drug manipulation. Conclusion The prevalence of drug manipulation to obtain the prescribed dose in Kenyatta National Hospital paediatric in-patient units is comparable to resource rich settings. Tablet manipulation involving tablet segmentation and dispersion was common. Development of a drug manipulation policy and procurement of age-appropriate formulations is recommended.