title: Manipulating tablets and capsules given to hospitalised children in Norway is common practice.
abstract: OBJECTIVE
  This study provided an overview of manipulating oral medicines given to hospitalised children and evaluated this practice in two hospitals. It focused on the type of manipulation and the dosage forms that were manipulated.
  
  
  METHODS
  This was a cross-sectional, prospective study, carried out on the paediatric wards at two Norwegian hospitals for four weeks in 2013. A medicine was said to have been manipulated if it was not administered as described in the Norwegian summary of product characteristics.
  
  
  RESULTS
  This study showed that 17% of the 3070 administrations of oral medicines to the hospitalised children involved manipulation. Tablets, including modified release preparations, were the most frequently manipulated medicines. In approximately half of these cases, only a segment of the unit dose was administered. No manipulation of oral liquids was seen. The bioavailability of as much as 44% of the most frequent given substances may be sensitive to such manipulations due to limited aqueous solubility. Various routines for splitting and handling the unit doses were observed.
  
  
  CONCLUSIONS
  Manipulation of oral medication was regularly performed on paediatric wards. There is an urgent need for age-appropriate medicines, documented and standardised processes for manipulating medicines and staff training on the consequences of manipulation.
authors.affiliation: Hospital Pharmacy Enterprises, Oslo, South Eastern Norway.
authors.forename: Kathrin
authors.initials: K
authors.lastname: Bjerknes
authors.affiliation: Hospital Pharmacy Enterprises, Oslo, South Eastern Norway.|School of Pharmacy, University of Oslo, Oslo, Norway.
authors.forename: Silje
authors.initials: S
authors.lastname: Bøyum
authors.affiliation: School of Pharmacy, University of Oslo, Oslo, Norway.
authors.forename: Solveig
authors.initials: S
authors.lastname: Kristensen
authors.affiliation: Hospital Pharmacy Enterprises, Oslo, South Eastern Norway.
authors.forename: Jørgen
authors.initials: J
authors.lastname: Brustugun
authors.affiliation: Department of Medicinal Product Assessment, Norwegian Medicines Agency, Oslo, Norway.
authors.forename: Siri
authors.initials: S
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004304:Dosage Forms; D004333:Drug Administration Routes; D016503:Drug Delivery Systems; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D009664:Norway; D010371:Pediatric Nursing / Q000379:methods*; D011446:Prospective Studies
chemical_list: D004304:Dosage Forms
keywords: Licenced medicine ; Manipulation; Off-label prescribing; Oral medicine; Paediatrics