Meds IQ | Safe Prescribing | Prescribing errors

Paediatric prescribing pocketguide

Paediatric prescribing pocketguide implementation in a busy district general hospital in London.

The problem

There was uncertainty amongst new starters regarding prescribing in paediatrics.  There had also been a serious incident where a baby was given an extra dose of gentamicin, which was the subject of much debate.  This highlighted the need for a prescribing guide in paediatrics, similar to one that was available for adults.  There are some key differences in prescribing in an adult and a paediatric population, and the aim of this guide was to clarify any uncertainties and to lay out basic prescribing rules.


In children, the risk of medication errors is often exacerbated by the need for calculations to determine the dose.  Prescribing errors in children can lead to significant morbidity and mortality.

The aim of this project, a paediatric prescribing pocket guide, is to improve prescribing practice in paediatrics, thereby improving patient safety and reducing delays in patients receiving and benefiting from intended treatment.

Making the case for change

I discussed the idea with senior medical staff, nurses and the paediatric lead pharmacist.  They agreed that the guide was a good idea.  I went on to design the prescribing guide, using national and Royal Colege guidelines.  The guide was then reviewed by the paediatric lead pharmacist and other paediatric pharmacists, as well as my clinical supervisor and head of paediatrics.  The guide was then sent to the Drugs and Therapeutics Committee to be approved.  Once approval had been obtained, the guide was discussed at senior level and published on the intranet, available to print out for those who preferred a hardcopy.

Your improvement

After identifying areas that needed improvement through the first cycle of an audit project, I went on to design and implement the paediatric prescribing pocketguide.  I subsequently presented the project at a departmental meeting . Re-audit 4 months later showed an objective improvement in prescribing practice, with mean prescribing error rate reducing from 28% to 10%.

Learning and next steps

Secrets to success are remaining open minded and flexible throughout the process. For example, I was originally hoping to have the guide available only as hardcopies and distributed to everyone in the department. After discussion with the department lead, we came to the agreement that making the guide available on the intranet would be more cost effective, as well as being easier to access for staff members as hardcopies are often lost.

Next steps involve constantly updating the guide to ensure it is up to date and relevant.  My contact details are available on the guide to ensure this is possible.

Quality assurance/MHRA Registration

Approved by local trust and drugs and therapeutics committee.

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