Aim It has been identified that children aged as young as four could potentially swallow tablets.¹ ‘Pill Schools’ have been created in hospitals across the UK with the aim of teaching children to swallow solid oral dosage forms, such as tablets or capsules. Solid dose forms offer significant advantages over liquids for patients, families and healthcare professionals across primary and secondary care.² Whilst this has been successfully implemented within several Trusts, there is no standardised toolkit available nationally to support this. Members of the paediatric team at Nottingham University Hospitals (NUH) are currently implementing ‘Pill School’ using resources provided as part of the ‘KidzMed project’² and have devised a toolkit to support other Trusts with launching this scheme.

Method We were inspired by the work from the Northern Paediatrics Kidzmed project. Following a pilot using a ‘pill swallowing kit’ in one clinic, a bid was successfully submitted to the hospital charity to produce additional kits to enable easy access to resources in wards and clinics. These were allocated to the play specialists, after a training session, and staff were also signposted to the Kidzmed e-learning.³ A project steering group was set up to implement training, kit maintenance, a communication strategy, data collection and evaluation, with the aim to roll out to two wards initially.

Kits contained water bottles with straws (which give a good flow of water to aid with the swallowing technique), cake decorations, other small sweets and dummy capsules to practice with, and a guide to running a session. Train the trainer sessions were offered to build staff confidence and promote the project.

Additional visual resources were developed, including a poster, screensaver and a logo to use on stickers and certificates. Questionnaires were designed to collect patient and medication details and to allow follow up for qualitative and quantitative data analysis. Letter templates were created for GP surgeries to provide updates about training provided in hospital, if this had been successful and if any drug formulations could be switched.

Outcomes We are at the point of implementing this across a small number of wards initially with the aim of scoping this out to the entire Children’s hospital across inpatient and outpatient areas. Initial progress has been slower than hoped due to time taken to set up processes and produce resources but we now aim to expand quickly to fully understand and appreciate the benefits to patients and primary and secondary care teams. Involvement of play specialists and the dedicated pharmacy technician time has been key to facilitate patient training and collection of data. Our aim is to identify cost savings that can hopefully be utilised to maintain pharmacy technician support as part of the wider roll out of the project.

References

1. Bracken L, McDonough E, Ashleigh S, et al. Can children swallow tablets? Outcome data from a feasibility study to assess the acceptability of different-sized placebo tablets in children (creating acceptable tablets (CAT)). BMJ Open 2020;10: e036508.

2. Tse Y, Vasey N, Dua D, et al. The KidzMed project: teaching children to swallow tablet medication. Arch Dis Child 2019:105:1105–1107 Doi:10.1136/archdischild-2019–317512.

3. NHS England. Kidzmed: An e-Learning resource for healthcare professionals teaching children to swallow pills. https://www.e-lfh.org.uk/programmes/kidzmed/