QI Blog: February 2020

Dr James Moss, Paediatric GRID Trainee at Health Education West Midlands, shares quality improvement work currently undertaken in clinical pharmacology around paediatric polypharmacy and deprescribing.

By meganpeng · February 26, 2020

Paediatric Polypharmacy and Deprescribing: Clinical Pharmacology QI

As a GRID trainee in paediatric clinical pharmacology I am interested in how medicines are prescribed, and more specifically whether they are prescribed appropriately. A recent audit spanning 12 months (in the secondary and tertiary hospital in which I currently work) identified 668 children were receiving >10 drugs concurrently, while 30 were receiving >20 drugs at any one time.

There is no doubt that the medicines we use today have improved child mortality but the adverse drug reactions associated with medicines can be distressing for the children and their carers. They can also lead to increased hospital admissions, and this risk can increase with the number of medicines taken. It is therefore important that prescribers consider not just “do they need this medicine”, but “do they need all these other medicines they are already taking” and thinking about deprescribing to avoid the increasing tendency to polypharmacy.

Sometimes a lot of medicines is entirely appropriate, but when it causes more harm than good it can be considered problematic polypharmacy, and in adults and the elderly this is well described in the literature. There are in fact, deprescribing tools and guidelines available for adult patients. However, a systematic review performed by myself and colleagues found that there were no paediatric specific guidelines. With the increasing number of children taking more medicines, we in the paediatric clinical pharmacology community, believe such a guideline is required. My educational supervisor and I will be collecting prescribing data from polypharmacy ward rounds with the aim of developing a paediatric specific deprescribing guideline for all to use. In the meantime, please think carefully before prescribing that medicine: Is it really needed? Is it being started just to treat the side effect of another medicine? And maybe most importantly, are there any medicines that are no longer needed that can be stopped?


Dr James Moss

Paediatric GRID Trainee at Health Education West Midlands

Trainee Representative for the Paediatric Clinical Pharmacology and Therapeutics CSAC


Find out more about the paediatric clinical pharmacology community here