Aim: Due to a lack of age-appropriate formulations, administration of drugs to children remains a challenge. This study aimed to identify the problems experienced in both the outpatient setting and the clinical setting. Methods: Between June 2017 and January 2018, we performed a cross-sectional, prospective study at the Sophia Children’s Hospital, The Netherlands. The study comprised of a structured interview on drug manipulations with parents visiting the outpatient clinic, and an observational study of drug manipulations by nurses at the wards. Results: A total of 201 questionnaires were collected, accounting for 571 drugs and 169 manipulations (30%). Drug substances that were most often mentioned as manipulated were macrogol (n = 23), esomeprazole (n = 15), paracetamol (n = 8), methylphenidate (n = 7) and melatonin (n = 7). Of all manipulated medicines, 93/169 (55%) were manipulated according to the instructions or recommendations of the Summary of Product Characteristics (SmPC) or patient information leaflet. During the observational study, manipulation was performed by 21/35 of observed nurses (60%), of whom 11 deviated from the hospital protocol for manipulation or SmPC (52%). Conclusion: Manipulation was a widely used method to administer drugs to children. Validated information regarding manipulation of drugs for both parents and nursing staff is needed.

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Keywords Compliance, Drug administration, Oral medication, Paediatric medicines, Paediatric nursing
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Journal Acta Paediatrica: promoting child health
van der Vossen, A.C, L. Al-Hassany (Linda), S. Buljac (Sandra), J.-D. Brugma (Jan-Dietert), Vulto, A.G, & Hanff, L.M. (2019). Manipulation of oral medication for children by parents and nurses occurs frequently and is often not supported by instructions. Acta Paediatrica: promoting child health, 108(8), 1475–1481. doi:10.1111/apa.14718