RCPCH/NPPG joint standing committee on medicines, best practice consensus guidelines for medication safe paediatric ward rounds, December 2023

The ward round represents an important opportunity for all aspects of a patient’s care to be reviewed, including medications. Errors with medications have significant patient safety implications in addition to costing the National Health Service millions of pounds in claims settlements per year.1 The potential for medication errors in paediatrics is especially significant. Research suggests that around a third of medication errors in paediatric patients may result in patient harm,2 indicating that this is an important area in which to target improvement. The joint Royal College of Paediatrics and Child Health and Neonatal and Paediatric Pharmacy Group Medicines Committee developed these recommendations for all children and young people (CYP) up to the age of 18. This was recommenced by the HSIB (Healthcare Safety Investigation Branch) following a significant incident in which a 4-year-old child developed an intracranial bleed following a prescribing error for an anticoagulant 10 times more than the correct dose. The child received this incorrect dose five times before this was recognised.3 The Royal College of Physicians and the Royal College of Nurses have jointly developed recommendations for modern ward rounds for adult patients, which includes a dedicated medication review. National Institute for Health and Care Excellence guidance published in 2015 on the optimisation of medicines sets out guidelines on medication reconciliation and review and emphasises the importance of effective communication and shared decision-making. ### Resources 1. The guideline—medication safety: best practice for effective paediatric ward rounds. 2. National Institute for Health and Care Excellence (NICE) guidelines on optimisation of medications including recommendations for medication reviews. 3. Medicines for children: Resources aimed at paediatric patients and their families containing useful information about medications. ### Improving the content and structure of a paediatric ward round For CYP in hospital, the ward round following admission should establish: