Erratum: Zahn et al. Manipulation of Medicinal Products for Oral Administration to Paediatric Patients at a German University Hospital: An Observational Study. Pharmaceutics 2020, 12, 583

A Training for Parents Prevents Clinically Relevant Handling Errors in the Use of Long-Term Antiseizure Medication

BACKGROUND

Medication handling errors (ME) in long-term antiseizure medication (ASM) compromise patient safety. Training programs to prevent those errors by parents are scarce.

PATIENTS

The intervention concept is designed for parents of children and adolescents aged 0-18 years with at least one long-term ASM.

METHOD

In a controlled prospective study, we assessed ME of ASM during home visits 3-6 weeks after a patient's in- or outpatient hospital visit (outpatient neuropediatric clinic and Social-Pediatric Center (SPZ)). We investigated the effectiveness of a patient specific, risk-adapted training (intervention group, IG) compared to routine care (control group, CG). For 54 ME in ASM handling, an expert panel classified the clinical risk ranging from Score-0 (no risk) to Score-6 (maximum risk) with the lowest risk actually classified as Score-3.

RESULTS

We analyzed data from 83 parents in the CG and 85 in the IG who administered 140 ASM per group. The intervention reduced ME per patient from 5 (median; Q25/Q75 3/9) to 4 (2/8; p=0.018). A total number of 589 ME occurred in the CG, 432 in the IG. ME in ASM handling rated Score-6 occurred once in the CG and not in the IG. A relative-risk-reduction (RRR) of ME (with p<0.001) was observed, with a RRR of 55.0% for Score-5, 27.6% for Score-4, and 23.1% for Score-3. RRR was 56.6% for ASM preparation (p<0.001) and 22.4% for oral administration (p=0.045).

CONCLUSION

Compared to controls, ME with high clinical risk significantly decreased in the IG after the training. Drug safety in chronically ill children with ASM was thereby improved.

Assessing the Appropriateness of Formulations on the WHO Model List of Essential Medicines for Children: Development of a Paediatric Quality Target Product Profile Tool

The World Health Organization's Model List of Essential Medicines for Children (EMLc) presents a list of the most efficacious, safe, and cost-effective medicines for priority conditions, intended for use in children up to 12 years of age. However, gaps in global availability and use of age-appropriate formulations of medicines for children still exist. To address these shortcomings, a comprehensive analysis of the appropriateness of formulations of essential medicines for children is being undertaken through the Global Accelerator for Paediatric Formulations (GAP-f) network, a WHO network launched in 2020 to respond to the paediatric treatment gap. This article describes the development and application of a paediatric Quality Target Product Profile (pQTPP) tool by WHO, to retrospectively evaluate the paediatric age-appropriateness of formulations on the EMLc and identify potential formulation gaps, to inform the review of the EMLc in 2023. A combination of paediatric-centric and global health-focused attributes and targets were defined, taking into consideration regulatory agency paediatric development guidelines and literature sources, and a qualitative scoring system was developed and tested. Example evaluations of paracetamol and clofazimine are provided, illustrating the tool's use. The assessment of EMLc formulations is ongoing and shortcomings and gaps in EMLc formulations have already been identified. The pQTTP tool may also be applied to national lists and prospectively when designing new paediatric formulations.