Award Title: Medicines Optimisation in Paediatric Patients (MOPPet): A qualitative human factors study on the causes of Drug Related Problems in hospitalised children.
Funder: Health Education England

Abstract: Medication safety in children is of great concern with the incidence of paediatric medication error rates estimated at approximately 20%. However, medication errors and adverse drug events (ADEs) are only part of the problem. Drug Related Problems (DRPs) include errors and harms, but also include include sub-optimal use of medicines and those issues with medication that are related to patient acceptability.It is estimated that the incidence of DRPs in children is 40%.This research seeks to understand how DRPs arise in paediatric in-patients. Following the MRC framework for the development of complex interventions, I will use sociotechnical theory and human factors engineering methods to describe medication processes in children's wards, and to use this theoretical understanding to develop recommendations for intervention development. There will be three work packages:WP1 - The current evidence base will be identified. A systematic review of the literature relating to interventions to reduce the incidence of medication error in paediatrics will be undertaken and will also include drug related problems as an outcome. The Cochrane EPOC group's systematic review methodology will be adopted. Appropriate databases will be searched, as will public policy databases and the grey literature. WP2 - a qualitative exploratory study is proposed to develop theoretical understanding of current practice, and to model the systems around medication use in children in hospital. I will use work domain analysis (WDA) to map the medication process in six different hospitals in the north of England. WDA is a cognitive engineering technique that identifies how people, purposes, the environment and tools and technology interact in a task or process. This will also capture how processes are adapted to ensure the task goals are achieved. Multiple data sources will be used to build the WDA: Procedures, policies and guidelines will be used to construct how the process is supposed to function Participant observation will be used to describe and identify how processes are delivered in practice, and also to describe the contextual information surrounding the way people interact with each other, their environment and the tools they are provided with to complete the tasks. In-depth interviews with patients, carers and staff will be used to understand the experience of medication use and the processes and the environment in which they work. Documents, field notes and interview transcripts will be analysed inductively and brought together to form the WDA. The WDA will be validated with a number of focus groups consisting of staff and experts, and a validation focus group specifically for children and young people.WP3 - Recommendations for interventions will be developed in partnership between patients, the public and professionals using the principles of experience-based co-design (EBCD). Experienced facilitators from partner institutions and members of the research team will undertake two consensus workshops. Health professionals, patients and carers will be presented with the findings from WP2 and asked to work together to propose interventions that can then be tested in later studies.This study involves the public in the design of safety interventions, which is novel. By using cognitive engineering theories, interventions that are developed in this study are likely to be more effective than those used previously. The recommendations will then go forward to develop a strategy for medication safety research in paediatric care supported by patient safety collaboratives.

Lay Abstract: Children and young people are at greater risk of drug related problems.Currently everything that the NHS tries to do to improve medication use in children is related to reducing how often errors happen. However, very little research has focussed on how to maximise the benefit of medicines for children, which may lead to better health outcomes for them. There are many other things about medicines that might cause harm to children that are not necessarily related to errors - these are called Drug Related Problems and can include side effects or issues that stop patients taking their medicine. This study aims to understand what nurses, doctors, pharmacists and patients do in the real world that may lead to drug related problems happening.I will observe healthcare professionals in hospital wards and departments, in particular to find out how they work with patients and carers, with each other and how they use tools, technology and information that is available to them. I will interview these people about their experiences and will build a model to explain how medication tasks run in real life.Using the results of this research, I will then work with health professionals and patients to develop recommendations for different ways of working that we can then test in later studies.Patients and the public will be involved throughout this research. I intend to have two parent representatives on the group that oversees the research project to provide me with advice and guidance on how the study should be run from the public perspective. Because I am studying medicines use with children and young people, I will also set up a children and young persons advisory board. The SMG and YPAB will provide input into the design and delivery of all aspects of the research. The YPAB will also help me design information about the research for children and young people and will also help me to understand the data that I collect during the project.As the research progresses, I will present the findings at scientific conferences and will also write papers for scientific journals. In addition I will also work with the YPAB to explore how we present the findings to children and young people, to help them understand what medication processes are like in hospital and to show service users how we will attempt to make them safer.

Research Activity Codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health Categories: GENERIC HEALTH RELEVANCE