Creating a Pill School – The Kidzmed Project
Creating a pill school to teach children and young people how to take tablet medication.
Tablets are safer, more convenient and cheaper than liquid medications. Children and young people (CYP) often remain on liquids due to habit, reluctance to change or staff and parents’ lack of knowledge about switching to tablets.
This initiative started off within one team in our children’s hospital to train staff and embed a system of looking for and converting eligible children to tablet medication.
Making the Case for Change
This was a truly multi-professional team project. Teaching children to swallow pills is not new, we partnered with our ID team who have been teaching children how to swallow HIV medication for many years when there was no alternatives. Nurses and parents were keen as there are lots of practical downsides (short duration, teeth decay, taste) to liquid medication.
Working with families and teams, we have an interactive training package with training video and comic poster. We ran interactive hour-long training sessions for staff. Using positive reinforcement and play, the trainer sat facing the learner with sweets or dummy capsules filled with sweets of increasing sizes.
We overcame practical barriers by placing easily accessible ‘switching kits’ in clinic filled with the necessary dummy pills, awards and certificates. In the initial test of change in one team, over three months, 90 CYP were seen in 13 multi-disciplinary renal clinics, 25 were suitable for conversion to tablet medication. 21 CYP (median age 8.4 years range 5.1 to 15.5) were successfully converted (only one patient required two sessions).
36 medicines were switched, generating £46,588 per year recurrent savings. Feedback was good. Staff liked the opportunity for positive interaction with children and families appreciated the ease of obtaining tablet medications versus liquids.
Learning and Next Steps
- Make learning fun. Learn in teams who normally work together
- Data collection is not difficult but does need close steerage. Once we had enough cost improvement data it opened doors to organisational leaders to help spread the project
- Patient and parents involvement at all stages is really helpful and helps drives the project as the improvement transformed their lives and they are keen to share their experiences
Teaching tablet swallowing is easy. This is not a new idea and we know of individual clinicians who have been teaching their patients how to swallow tablets for many years.
Read the full publication in Archives of Disease in Childhood: Tse Y, Vasey N, Dua D, et al. The KidzMed project: teaching children to swallow tablet medication. Archives of Disease in Childhood. Published Online First: 08 October 2019. doi: 10.1136/archdischild-2019-317512.
Project Lead: Yincent Tse, Consultant Paediatric Nephrologist; Nicola Vasey, Lead Paediatric Pharmacist; Ailsa Pickering, Senior Sister in Paediatric Infectious Disease; Emma Lim, Consultant Paediatrician.
Organisation: Great North Children’s Hospital, Newcastle upon Tyne