Vomiting of oral medications by pediatric patients: survey of medication redosing practices.
BACKGROUND
At the time of this study, the authors' pediatric tertiary care hospital had no policy to guide actions when a child vomited after ingesting oral medication, and limited information was available in the literature.


OBJECTIVE
To characterize this clinical problem at the study hospital, to identify current practices related to redosing of medications at the study hospital, and to collect guidelines and opinions of health care professionals at other pediatric hospitals on this topic.


METHODS
Two online surveys were conducted, each over a 1-month period in late 2010, to identify current practices and opinions of pediatric health care professionals about redosing of medications after vomiting. E-mail distribution lists and health care forums were used to recruit participants.


RESULTS
Of the 76 responses from the study hospital, 65 were suitable for analysis. Many respondents reported encountering vomiting after administration of oral medications on a weekly (25 [38%]) or monthly (24 [37%]) basis. Most of the respondents reported that they would follow a general rule to redose if vomiting occurred within 30 min (39 [60%]) or 15 min (21 [32%]) after initial ingestion. When respondents were asked to rate the importance of 8 factors potentially affecting the decision to redose, more than half indicated that time after dose ingestion (59 [91%]), medication type (45 [69%]), patient status (39 [60%]), and visibility of medication in the vomitus (36 [55%]) were very important. Of the 53 respondents to the survey of health care professionals at other institutions, 16 (30%) indicated that their pediatric hospital or ward had a guideline on redosing in cases of vomiting after administration of oral medications. Most respondents (12/13 [92%]) stated that the guideline took into account the interval between initial ingestion and vomiting.


CONCLUSIONS
The problem of vomiting after administration of an oral medication was prevalent at the study hospital, and guidelines were scarce at other pediatric institutions. Health care professionals at the study hospital and other institutions listed the time between ingestion and vomiting as the most important factor in the decision to redose the medication.
, BScPharm, PharmD, is a Clinical Pharmacist in the Pharmacy Department, Children's and Women's Health Centre of British Columbia, Vancouver, British Columbia.
Jennifer G
JG
Kendrick
Kelly
K
Ma
Pia
P
Dezorzi
Don
D
Hamilton