Kapsule Kids at Great Ormond Street Hospital

Project completed as part of the Great Ormond Street Hospital Green Team Competition.

Team members:

Snehal Bakrania, Medicines information pharmacist

Sadhna Ayesha Sharma, Cardiology Pharmacist

Setting / patent group:

paediatric heart and/or lung transplant patients

Issue:

Liquid medication is often the default choice in paediatric prescriptions due to the assumption that it is easier to administer in children. There are several setbacks to relying on liquid medication including shortages of raw materials and the formulations being more expensive and harmful to the environment. Evidence suggests children as young as three can safely swallow tablets and capsules, leading to successful initiatives like Pill School at Evelina London Children’s Hospital and the KidzMed project at Great North Children’s Hospital. Following suit, Great Ormond Street Hospital implemented a similar program to train post-heart and lung transplant patients to take tablets, aiming to transition lifelong medication recipients to more sustainable formulations. There is an average of 20 heart and/or lung transplant patients at GOSH per year who require expensive medications, often for their lifetime. We focussed on this population for a trial of our changes.

Intervention:

Transplant medications that were included in this project consisted of tacrolimus, mycophenolate mofetil (MMF), paracetamol and co-trimoxazole. Eligible patients were identified by an MDT. Training was conducted by the ward pharmacist and ward MMT using techniques outlined on the KidzMed training platform, Evelina’s Pill School protocol and through development of our own pill information booklet for patients. The Cardiac Ward pharmacist would have a discussion as soon as they stepped down from CICU to explain the aims of Kapsule kids to the patient and their parents/carers. Upon agreeing to participate, the patient’s take home medicines were prescribed as tablets and dispensed to the ward soon after to facilitate early training in the controlled environment of the ward prior to discharge.

Outcomes

In the project period 5 patients successfully transitioned to tablets instead of liquid medications. Projected savings below are based on transitioning 10 patients a year and include 1 year’s supply of tacrolimus and mycophenolate mofetil (MMF) and a 6 week supply of co-trimoxazole (from then provided by local pharmacy. Clinically, patients and families reassured that swallowing tablets is safe May improve compliance due to poor palatability of some liquid medications. Address concerns regarding national co-trimoxazole liquid shortage 329 kgCO2e per year, equivalent to driving 972 miles in an average car. £258,255 Socially, Tablets easier for families to transport and store, and have longer expiry dates once opened. Contributes to improving long term independence for young adults Ward nursing staff save time as drawing less liquid medicines. Pharmacy team found supporting children to learn a new skill satisfying to their job role, however the project did come with a burden on time for an already very busy team. Reduced need for MMF liquid which carries teratogenic risks to pregnant staff.

Key learning point

There are many benefits to training patients on how to take pills from an early onset including improved adherence, cost savings, better continuity of care and is more environmentally sustainable. Simply asking patients if they would like to attempt taking pills can lead to patient engagement. Easing parent and carer anxiety is the key to encouraging children to take tablets and capsules and finding a vehicle of delivery that is acceptable to the patient. creating a safe and comfortable environment with room for an open discussion has been the main driver in the success of this project. Empowering the patient through direct conversation has provided us the success to sustainability.