Lack of national formulary integration is a ‘critical gap in paediatric medication safety’

A ‘critical gap in paediatric medication safety’ exists due to a lack of national formulary integration with electronic prescribing, several paediatric bodies have said.

In a joint position statement, the Neonatal and Paediatric Pharmacy Group (NPPG) and the Royal College of Paediatrics and Child Health (RCPCH) said there is an ‘urgent need’ to prevent medication errors in children.

These errors persist despite the growing use of electronic prescribing and medicines administration (ePMA) systems, and risk causing significant harm or even death.

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The organisations called for the British National Formulary for Children (BNFC) to be integrated into all ePMA systems and warned that the current lack of national formulary integration is a ‘critical gap in paediatric medication safety’.

The BNFC serves as the authoritative resource for paediatric prescribing guidance in the UK. It is published under the joint imprint of the British Medical Journal, Pharmaceutical Press, the Royal College of Paediatrics and Child Health, and the Neonatal and Paediatric Pharmacy Group.

The position statement also stresses the need for advanced clinical decision support tools tailored to address paediatric weight-based and condition-specific dosing requirements, which ‘remain unmet at present’.

The paediatric bodies refer to a report published by the Healthcare Services Safety Investigation Branch (HSSIB) in 2022, which found that medication errors in children continue due to inaccurate dosing calculations and unsuitable electronic system configurations.

Paediatric prescribing is inherently personalised, requiring calculations based on each child’s weight, age, gestation, body surface area, and the specific condition being treated.

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Several stakeholders responded to the report, recognising the significant risks identified, including the Medicines and Healthcare products Regulatory Agency (MHRA), NHS Digital, the National Institute for Health Research (NIHR) and the Care Quality Commission (CQC).

However, the new position statement feels that progress is ‘uneven’ and several recommendations remain unmet.

It added: ‘Despite recognising the need for specialised adaptations in ePMA systems to improve paediatric safety, many critical recommendations remain unmet, leaving significant safety risks unaddressed.

‘The report also lacked detailed guidance on implementing proactive, paediatric-specific decision support, an area where stakeholder responses have made limited progress.’

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In their joint statement, the paediatric organisations recommend that:

• All ePMA systems should address specific safety issues as outlined in the statement;
• BNFC-based dosing should be used across the UK as the basis for ePMA systems to calculate paediatric dosages and set safety dose limits;
• Local guidelines may be needed to supplement BNFC, but these additions should be limited to genuinely necessary cases and should be clearly marked to distinguish them from national standards;
• The setting up a process for sharing variation in practice with the RCPCH for others to learn from and a commitment from providers to share this variation with the RCPCH to ensure other providers can learn and improve;
• Key stakeholders including the RCPCH should consider developing paediatric specific standards with associated measures and improvement support tools.