Paediatric Nursing Skills for Australian Nurses

Introduction

This chapter will review common modes of medication delivery in paediatric patients including oral, topical and parenteral modes, to assist you to develop your skills in this vital area of practice.

Due to infants’ and children's anatomical, physiological and developmental differences, administering medications to paediatric patients requires specialised knowledge and skills. Nurses caring for paediatric patients need to be aware of the differences between paediatric and adult patients, and how they impact on medication administration.

First, this chapter will provide an overview of important safety considerations when administering medications to paediatric patients. This is followed by a section on calculating paediatric doses of medication. The third section covers the different routes of medication administration commonly used in paediatric settings.

Safety considerations in paediatric medication administration

Medication administration is a high-risk activity in any setting, but poses even more of a risk in the paediatric setting for many reasons. Children are more at risk of serious harm if a drug error is made, and it is also known that medication errors occur three times more frequently in paediatric settings than in adult settings (Gonzales, 2010; Lan et al., 2014).

Reasons for this include the paediatric patient's immature body (Manias et al., 2013) and the child's inability to communicate if side-effects are an issue, the complex calculations involved, and having to use formulations that are suitable for adults and not children, then modifying them for children (Lan et al., 2014). This often results in the need to manipulate the medication by crushing, dissolving or splitting tablets (Niemann et al., 2014). The most common types of errors in an Australian study of hospitalised children's medication charts were found to be incorrect dose, medication frequency or route (Manias et al., 2013).The most cited reasons for errors, according to nurses, are distractions and interruptions, high nurse-to-patient ratios, the number of medications to be administered and not double-checking doses with at least one other Registered Nurse (Gonzales, 2010).