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RanitidineAugust 5 2015

Data looking at the level of dispensing incidents around liquid ranitidine preparations for children has prompted a number of recommendations to reduce further incidents.

Pharmacy Voice has extrapolated prescription data from 6,796 pharmacies and suggests that potentially 60 dispensing incidents involving ranitidine liquid for children in England occur every year. Around 70% of these incidents affect children under the age of two, it says.

“From these findings, Pharmacy Voice believes that further implementation of robust procedures in community pharmacy could help to reduce the prevalence of ranitidine incidents involving liquid preparations.”

The pharmacy owner representative organisation used internal company reporting systems from a number of multiples to collate data on dispensing incidents involving liquid ranitidine preparations in 2013-14. “Cautious proportional extrapolation of the data suggests that, at the national level of around 11,500 pharmacies in England, in the region of 60 dispensing incidents may occur each year affecting babies and children prescribed ranitidine liquid preparations,” it has concluded.

“Using further cautious extrapolation, over 40 of these incidents (70%) are likely to affect babies under 2 years old ... whilst this is a low rate, there are still 60 patients who have been issued with the incorrect dosage of their medication and whose families may have experienced distress as a result of these incidents.”

Pharmacy Voice says “there is clearly room for improvement” and its Patient Safety Group has shared learning on what individual companies are doing to reduce the number of dispensing incidents.

Among the recommendations it makes to improve dispensing for children are:

  • check the date of birth on a prescription and if the prescription is for a patient under the age of 12, this should be highlighted by the pharmacy team member who receives the prescription
  • any medication which has been prescribed outside the recommended age range should be discussed with the prescriber
  • the prescriber should be reminded that this is an unlicensed indication, and carries additional liabilities and responsibilities for healthcare professionals involved
  • consider the suitability of the prescribed medication for the individual child or infant, including the active and other ingredients
  • dosage calculations need to take young patients’ body weight into consideration
  • the dose needs to be made clear to parents or carers on the exact volume in ml (especially when the intended dose may have been indicated in mg)
  • pharmacies should ensure that small enough oral syringes are always in stock and supplied with the prescription to make measuring out prescribed doses easier for the parent or carer.

Janice Perkins, a Pharmacy Voice board member who chairs its Patient Safety Group, said: “Dispensing incidents affecting babies and children are particularly traumatising for patients’ families, and for pharmacy staff. We hope that by providing some recommendations and effective shared learning for pharmacy teams, we will be able to reduce the occurrence of these unfortunate incidents.

“Whilst we may be looking at one particular medicine in this instance, Pharmacy Voice’s Patient Safety group has developed recommendations aiming to help reduce the occurrence of incidents involving all liquid preparations for babies and children. We are passionate about driving the patient safety agenda across the board, developing practical solutions to issues that impact us all in our working practice.”

The announcement was made to highlight Pharmacy Voice publishing its first Patient Safety Bulletin. This says that future patient safety issues the Group will be looking at include:

  • safeguarding vulnerable adults and children
  • pharmacy processes in place to reduce the occurrence of incidents involving insulin
  • the role of social media in the handling of incidents
  • ways to increase the reporting of and subsequent learning from patient safety incidents with regard to the recent rebalancing medicines consultation.

Links:

Pharmacy Voice announcement on ranitidine    

PV report: ‘Incidents involving ranitidine liquid preparations for children’ July 2015   

PV announcement on Patient Safety Bulletin    

PV Patient Safety Bulletin    

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