A paediatric consultant has given Cystic Fibrosis (CF) patients more freedom in their everyday life by making one simple change to how they receive their medicine.
Paediatric Respiratory Consultant, Dr. Louise Thomson, launched Kidzmed Glasgow at the Royal Hospital for Children (RHC). This is an initiative to teach children as young as four years how to swallow pills, eliminating their need for liquid medicine.
It builds on success of the original Kidzmed project in the Great North Children’s Hospital, Newcastle which has won the NHS Sustainability Award, the HSJ Value Award for Pharmacy and Optimisation, and the Bright Ideas in Health Award.
Dr Thomson said:
“Liquid medications taste bad, are tricky to manage around day-to-day life, are expensive to prescribe, and have a negative environmental impact.
“However, many children are prescribed liquids as routine despite pill swallowing being a life skill that is easy to learn from the age of four or five years.
“Those being treated for lifelong conditions, such as Cystic Fibrosis (CF), take multiple medications per day. Swapping to pills will make a big impact to their lives.”
As part of Kidzmed Glasgow, hospital staff and play teams work with young patients in the RHC Cystic Fibrosis Clinic for half an hour (or less) to teach them how to swallow pills in a manner that resonates with their age and via the use of carefully designed support packs, funded by the Glasgow Children’s Hospital Charity.
Each pack included a water bottle, flavoured water, pill box, toothbrush, three sizes of sweets for practice, stickers, an information booklet, and a certificate to celebrate progress.
Dr Thomson continued:
“While liquid medicines may be considered easier for a child, we need to look at the bigger picture and think about their home life to improve our patient and family experience.
“Imagine being a parent or carer who is having to carry around multiple liquids that often need to be kept refrigerated. Longer day outings or travel become tricky.
“Then when a child starts school, they need to organise to have their liquids stored in a refrigerator for them too. Parents and carers need to replenish these via the pharmacy and often they can go to waste.
“The hope is by teaching children to swallow pills at a young age, their life will become easier.”
The pilot is now being rolled out in other areas due to its success. Dr Thomson is currently working with haematology and oncology. She explained:
“People around the hospital started to ask about the project and we realised that the volume of liquid medicine used by haematology, oncology and transplant patients (e.g. bone marrow transplant) is significant. Some of these children currently use nasogastric tubes for liquid medication.
“Many large syringes of medicine could be replaced with just a few pills, potentially leading to the removal of these tubes when not needed for nutrition. That’s a huge difference for a child.
“When you see one month of liquid medication for an oncology patient next to pill form, the impact of this is clear.”
Kidzmed Glasgow was created as part of a quality improvement project in line with NHS Greater Glasgow and Clyde’s Realistic Medicine initiative. Realistic Medicine improves patient experience, sustainability and aim to eliminate waste.
Dr Jude Marshall, Realistic Medicine Clinical Lead for NHS Greater Glasgow and Clyde, said:
“Realistic Medicine encourages clinicians to have conversations with patients and families to share decisions on future care plans, including taking of medication that align with what matters to them. This is called shared decision making and, in this case, if taking pills rather than liquids is important to the patient and their family for the benefits listed above then this will be central to making plans for the child and the family.
“Liquid medications can go out of date sooner which may mean the medicines have to be discarded. Pills have a longer life and so this along with the reduction in packaging have a big impact on how we are reducing waste around prescribing.
“Every day, NHSGGC dispenses around 100,000 medicines. Figures show that around 10% of all medicines (liquid and pills) are thrown away, either because they’re not needed or haven’t been taken. That’s the equivalent of more than £100,000 every day – thrown away.
“There is also a lot more packaging, and plastic involved for liquids and syringes.”
Dr Thomson has advised that the challenge now is to understand the barriers to prescribing tablet medication across the hospital and to use this knowledge to develop education and training programmes for staff.
Beyond the hospital, the project highlights a broader societal opportunity across Scotland, to teach pill-swallowing techniques to adults and children alike, improving quality of life.
