Neonatal and Paediatric Pharmacists Group
|
The Neonatal and Paediatric Pharmacists Group celebrated
its tenth anniversary this year. Hannah Pike (on the staff of The
Journal) reports from its annual conference that was held in Newcastle
Upon Tyne
this
week,
and
was attended by almost 200 delegates
|
The Neonatal
and Paediatric Pharmacists Group 10th
annual conference took place in Newcastle Upon Tyne from November
26–28. Joint sessions were held with the Academy of Pharmaceutical
Sciences.
|
NPPG celebrates its 10th anniversary
Recent developments in the field of neonatal and paediatric pharmacy
include the European Commission’s proposal for a regulation on
medicinal products for paediatic use, the launch of the Department of
Health’s paediatric
medicines strategy (PJ, 21 August,
p246) the publication of the National
Service Framework for Children, Young People
and Maternity Services (PJ, 25 September, p413) and the pending
launch of the British
National Formulary for Children (PJ, 3
April, p405).
At the NPPG conference this week delegates discussed how these developments
will be brought together to improve the pharmaceutical care of children
and neonates.
Building a safer NHS
Research into medication errors in paediatrics is getting better, Jim
Smith, chief pharmaceutical officer for England, told delegates, but
more research is still needed to help build a safer NHS. Dr Smith said
that in order to do this, better reporting of errors is essential.
He referred to the Department of Health’s 2000 report “An
organisation with a memory” which said that factors leading to
errors must be recognised to prevent them being replicated throughout
the NHS. He reminded delegates that the main thrust of the report calls
for better reporting in a blame-free culture, but acknowledged how
difficult this is to achieve.
Dr Smith said that although advances in IT such as electronic prescribing
and electronic transfer of prescriptions should help to reduce mistakes,
they will not solve the problems completely and errors will occur in
other ways.
Better access to information and decision support is also an important
step to ensuring safety, Dr Smith said. “The children’s BNF
is going to be so important in this field,” he explained, “and
every health care professional should have access to one”.
“
Human error is inevitable,” he concluded. “Medication is
generally safe but serious errors do happen and they happen too frequently.
The Government is really serious about improving patient safety in general,
and medication safety in particular, but we recognise there is no simple,
single solution. We need a systematic approach and the community of paediatric
pharmacists has a big role to play and is already doing so.”
What to expect from the BNF-C
Ian Costello: Layout different to the BNF |
George Rylance, chairman of the paediatric formulary committee of the
British National Formulary for Children (BNF-C), and Ian Costello,
editorial lead, outlined the aims of the BNF-C, which is expected to
be published in June 2005, and described what pharmacists can expect
from it.
The BNF-C aims to build on ‘Medicines for Children’ and
to provide an authoritative reference for the safe and effective use
of
medicines in children and neonates, as outlined in the Department of
Health strategy on medicines for children.
It is a collaboration between the NPPG, the Royal College of Paediatrics
and Child Health, the British Medical Association and the Royal Pharmaceutical
Society, and is designed for primary, secondary and tertiary care. It
will cover drugs used in practice in children from neonates to the age
of 18, both licensed and unlicensed.
Mr Costello described how the style of the BNF-C will follow the classifications
of the BNF, although the layout will be distinctly different. A key difference
is that
information contained in some of the appendices of the BNF such as the
use of drugs in pregnancy and during breast-feeding, will
appear in the monographs of the BNF-C. BNF-C will also contain information
on the administration of drugs and best practice guidance on the preparation
and sourcing of extemporaneous and unlicensed medicines. An electronic
and web-based version will be available a few months after publication
of the hard copy.
Mr Costello explained that health minister Lord Warner had said in August
that the Department of Health will support the distribution of the BNF-C
as it supports the distribution of the BNF to doctors, pharmacists and
extended nurse prescribers in England. He said that the publishers
are working with the Department of Health to firm up the distribution
process and that separate discussions are still under way on the distribution
of BNF-C in Scotland and Wales.
Draft EU regulation for paediatric products
Nathalie Seigneuret, scientific administrator at the European Medicines
Agency, outlined the draft EU proposal for a regulation on medicinal
products for paediatric use which aims to increase the availability of
medicines specifically adapted and licensed for use in this population,
and to make more clinical trial data available to both prescribers and
parents.
Dr Seigneuret summarised these draft regulations, which include a requirement
for paediatric data at the time of application for a new product. Rewards
for the studies conducted will be a six-month extension of the supplementary
protection certificate if corresponding paediatric data is incorporated
into the product’s summary of product characteristics. For orphan
medicinal products, an additional two years market exclusivity will be
granted for inclusion of this data.
Dr Seigneuret described how a paediatric expert group has been set up
by the Committee for Medicinal Products for Human Use to assess paediatric
needs in different specialist areas. Details of the EMEA proposals are
available at www.emea.eu.int
Speaking from the pharmaceutical industry’s perspective, Steve
Wicks, vice-president of science and technology at Pfizer Global Research
and Development, explained that one paediatric formulation can take up
to five years, and over £2.5m to develop, competing with the development
of drugs intended to meet unmet medical needs of adults. He said: “While
the incentive of six months additional market exclusivity is valuable,
it requires that revenues are maintained to the full extent of the patent
term and are not eroded by premature generic competition.”
He said that over the next 10 years the benefit of joint industry and
regulatory agency promotion of paediatric medicines will be felt, but
it is essential that paediatric pharmacists and the industry continue
to communicate with one another.
Paediatrics — a complex agenda
Professor Sir Alan Craft: We need a cultural change |
The Government is genuinely taking children’s health seriously,
Sir Alan Craft, president of the Royal College of Paediatrics and Child
Health, told delegates. He said that the Government’s policy agenda
is complex, taking into account the Children Bill, the Chief Nursing
Officer’s review of nursing, midwifery and health visiting and
the White Paper
on Public Health (PJ, 20 November, p739). He pointed
out that a lot of the responsibility for the health of children that
used to lie with the Department of Health has been transferred to the
Department for Education and Skills after “Every child matters”,
the Government’s response to the Victoria Climbié inquiry.
However, despite this progress, inequalities among children are continuing
to rise, Sir Alan explained. For example, a large social divide still
exists with children born into the lower socio-economic classes having
lower birth weight and a higher risk of dying from an accident than the
higher social classes.
Children have not been made a priority in the NHS, Sir Alan told delegates.
He suggested that society does not place a high value on children, childhood
and parenting, and that key NHS targets are not relevant to children.
Sir Alan reminded delegates that a marker of good practice outlined in
the NSF for children is that “The contribution of pharmacists in
the effective and safe use of medicines in children is maximised”.
He acknowledged that change will take time and said: “We need a
cultural change in the way we think about and design children’s
services, especially working in partnerships.”
Current research in paediatric pharmacy
Several delegates presented their latest paediatric research findings
at the conference. These included
· Catherine Tuleu, lecturer at the Centre for Paediatric Pharmacy Research
at the University of London School of Pharmacy and winner of the 2003
Mandeville Medicines research award, described the safe use of the extemporaneous
preparation of sildenafil (Viagra) for children with pulmonary hypertension
· Simon Keady, lead directorate pharmacist, women and children, at the
Middlesex Hospital, described the benefits of a paediatric palivizumab
administration clinic
· John Bane, clinical trials pharmacist at Sheffield Children’s
NHS Trust, presented a drug use evaluation of omeprazole and its problems
when administering doses of less than 10mg and administration via a feeding
tube
· Amanda Bevan, directorate pharmacist at Southampton General Hospital,
presented an investigation of cystic fibrosis prescribing issues in primary
care |
The
Pharmaceutical Journal