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Introduction: Manipulation of medicines is often necessary in the paediatric setting due to lack of medicines suitable for paediatric patients. There are previous short-term frequency studies in different paediatric settings, but no long-term studies and no comparison between two different years in the same setting. In 2007 the Paediatric Regulation was implemented in Europe to stimulate drug companies to develop more information around medicines for children and new dosage forms suitable for paediatric patients. An alternative to manipulation of medicines is to use extemporaneous preparations in correct strengths. Aim: The overall research aim of this thesis was to study how and to what extent manipulation of medicines is being done and its effect on dosing accuracy in paediatric care. A specific aim was to compare the use of extemporaneous preparations in two different years. Methods: The setting for three of the four studies was a large paediatric university hospital in Sweden, and the fourth study was performed at a hospital pharmacy. Data for paper I and IV were extracted from a large registry containing material regarding patient data, care, and medicines from the hospital electronic health record, TakeCare. In Paper I data regarding all solid oral and rectal administrations where a part of a solid dosage form needed to be administered were counted. Comparisons were then made between the included study years 2009 and 2019 and between inpatients and patients at the emergency department. Semi-structured interviews with registered nurses and pharmacists were performed in Paper II. All interviews were audio recorded, transcribed verbatim, and analysed qualitatively using content analysis. In Paper III five different brands of tablets were split into halves and quarters. The resulting parts were then weighed and compared with expected weight, according to criteria in the European Pharmacopoeia and the United States Pharmacopoeia. The frequency of patients with at l

This is a registry-based study with the aim of describing and comparing the frequency of manipulations of solid oral and rectal medicines in 2009 and 2019 at inpatient units and an emergency department in a paediatric hospital within a Swedish university hospital. All patients aged 1 month-18 years with oral or rectal administrations were included. In total, 140,791 oral and rectal administrations were included in 2009, and 167,945 oral and rectal administrations were included in 2019. The frequency of patients receiving at least one manipulated oral medicine decreased between the study years, both in inpatient units and in the emergency department (from 19% to 17%, p = 0.0029 and from 11% to 5%, p < 0.0001, respectively). The frequency of patients receiving a manipulated rectal medicine also decreased between the study years, both in inpatient units and in the emergency department (from 22% to 10%, p < 0.0001 and from 35% to 7% 2019, p < 0.0001, respectively). The results show a decrease in the manipulation of both oral and rectal medicines to paediatric patients in 2019 compared to 2009. Even though this implies a safer practice, there is still a pronounced lack of child-friendly dosage forms and suitable strengths enabling the safe administration of medicines to sick children.

AIM: Studies on frequencies of manipulated medicines in paediatric care are common, but there is little knowledge of experiences of pharmacists and registered nurses in this area. The aim of this study was to explore registered nurses' and pharmacists' reasoning in the manipulation of medicines to paediatric inpatients. METHODS: Semistructured interviews with twelve registered nurses and seven pharmacists were performed at a Swedish paediatric university hospital. The interviews were transcribed verbatim and analysed using content analysis. RESULTS: Four major categories emerged from the analysis of the interviews: medicines management, knowledge, consulting others and organisation. Medicines management involved the process of drug handling, which is prescribing, reconstitution or manipulation and administration. Knowledge concerned both the knowledge base and how healthcare personnel seek information. Consulting others involved colleagues, registered nurses and pharmacists, between registered nurses, pharmacists and physicians and between registered nurses, pharmacists and caregivers. Organisation covered documentation, time and working environment. CONCLUSION: Both pharmacists and registered nurses stated that manipulation of medicines to paediatric patients was often necessary but felt unsafe due to lack of supporting guidelines. Pharmacists were natural members of the ward team, contributing with specific knowledge about medicines and formulations.