{
  "abstract": "Context, Situation or Problem Most children over the age of four can be taught to swallow pills, 1 but younger children, those with feeding tubes, or swallowing difficulties may require liquid or dispersible medications. A local sustainability project has demonstrated that omeprazole suspension is financially and environmentally costly. Suspensions also tend to have higher rates of dosing errors and are burdensome for families. In our tertiary paediatric service, omeprazole suspension remains over-prescribed despite previous interventions, leading to a restriction on its use. This project aimed to explore prescribing behaviours and support safer, more sustainable prescribing through the development of a proton pump inhibitor (PPI) prescribing decision aid.Eight paediatric doctors, from FY1 to senior registrar, took part in individual or small group sessions. Each completed a survey involving three clinical scenarios: a three year old unable to swallow pills, a child with a percutaneous endoscopic gastrostomy (PEG), and a 12 month old with a small nasogastric (NG) tube. Participants were asked to choose a PPI formulation (capsule, dispersible tablet, or suspension). If they selected omeprazole suspension, they were informed it was unavailable and prompted to choose another option. Participants also ranked clinical, social, cost, and environmental factors by influence on prescribing. Feedback was gathered on a draft version of a prescribing decision aid, which was refined iteratively.All eight participants had prescribed omeprazole suspension, with 75% having also prescribed capsules and 50% dispersible tablets. For the scenario involving the 3 year old unable to swallow pills, 86% ultimately chose an appropriate formulation, though 36% initially selected suspension and were redirected. In the PEG scenario, 86% ultimately selected a suitable alternative, with 25% being prompted to pick again after choosing suspension. In the small NG tube scenario, no prescribers selected a safe option after suspension was removed.When ranking decision-making factors, clinical considerations were rated highest, followed by social factors (e.g. storage and shorter expiry dates), then cost, and finally environmental impact. In group discussions, most prescribers were unaware of the high financial and environmental costs of omeprazole suspension. All participants found the draft decision aid useful and participants requested additional guidance on omeprazole versus lansoprazole selection and the use of sodium bicarbonate for dispersing tablets in small tubes.Conclusion or Lessons Learned This survey identified an important safety issue: prescribers are not aware of an appropriate formulation for small enteral tubes, therefore there is a risk of blocking these tubes with dispersible tablets mixed with water rather than sodium bicarbonate. Reinsertion of NG tubes causes distress to patients and costs time. We also discovered that many prescribers were unaware of alternatives to omeprazole suspension for children who cannot take pills. A prescribing decision aid was developed to address these issues, incorporating a decision flow chart and weight banded dosage options that correspond to an electronic prescribing order set. These resources have been distributed across the trust via email, posters and at departmental meetings. The intervention supports safer, lower cost, and more sustainable prescribing of PPIs in children.Reference Lim E, Parker E, Vasey N. Why learning how to swallow pills is good for patients, parents, and the planet. BMJ 2024;384:e076257",
  "authors": [
    {
      "affiliations": [
        "The Newcastle Upon Tyne Hospitals NHS Foundation Trust, UK"
      ],
      "name": "Lauren Hockley"
    },
    {
      "affiliations": [
        "The Newcastle Upon Tyne Hospitals NHS Foundation Trust, UK"
      ],
      "name": "Emma Lim"
    },
    {
      "affiliations": [
        "The Newcastle Upon Tyne Hospitals NHS Foundation Trust, UK"
      ],
      "name": "Louise Carr"
    },
    {
      "affiliations": [
        "The Newcastle Upon Tyne Hospitals NHS Foundation Trust, UK"
      ],
      "name": "Emma Vittery"
    },
    {
      "affiliations": [
        "The Newcastle Upon Tyne Hospitals NHS Foundation Trust, UK"
      ],
      "name": "Karen Hartley"
    }
  ],
  "title": "P57 Paediatric proton pump inhibitor prescribing – reducing the use of omeprazole suspension",
  "uid": "f8dc5ff8-d68e-5ea2-883c-40abb39ae897"
}