Drug storage and administration
Safe drug administration is every bit as important as safe and effective drug prescribing.
Neonatal prescribing : It is important to consider the practicalities of drug administration when prescribing, and to avoid prescribing absurdly precise doses that cannot realistically be measured. Such problems arise with particular frequency when body weight enters into the calculation. It is difficult to measure volumes of less than 0.05 ml even with a 1 ml syringe, and anyone who prescribes a potentially dangerous drug without first working out how to give it must inevitably carry much of the responsibility if such thoughtlessness results in an administrative error. Guidance on this is given in the individual drug monographs, with advice on prior dilution where necessary.
Equal thought should also be given to the timing and frequency of drug administration. Because many drugs have a relatively long neonatal elimination 'half-life', they only need to be given once or twice a day. More frequent administration only increases the amount of work for all concerned and increases the risk of errors creeping in. Parents are also more likely to give what has been prescribed after discharge if they are not asked to give the medicine more than twice a day!
Length of treatment : Remembering to stop treatment can be as important as remembering to start it. Neonatal antibiotic treatment seldom needs to be continued for very long. Treatment should always be stopped after 36–48 hours or sooner if the initial diagnosis is not confirmed. Babies with meningitis, osteitis and staphylococcal pneumonia almost always need 2–3 weeks' treatment, but 10 days is usually enough in septicaemia. Few babies need to go home on treatment; even anticonvulsants can usually be stopped prior to discharge (cf. the monograph on phenobarbital). Babies are often offered respiratory stimulants like caffeine for far longer than is necessary. Few continue to need such treatment when they are more than 32 weeks gestation: it should, therefore, usually be possible to stop all treatment at least 3 weeks before discharge. In the case of some widely used nutritional supplements (such as iron and folic acid), there was probably never any indication for starting treatment in the first place given the extent to which most artificial milks are now fortified (cf. the monograph on pre-term milk).
Storage before use : Most drugs are perfectly stable at room temperature (i.e. at between 5 and 25 °C) and do not require specialised storage facilities. Temperatures above 25 °C can be harmful, however, and some drugs are damaged by being frozen, so special thought has to be given to transport and dispatch. Some drugs are best protected from direct daylight, and, as a general rule, all drugs should be stored in a cupboard and kept in the boxes in which they were dispensed and dispatched. Indeed, in a hospital setting, all drugs are normally kept under lock and key.
Hospital guidelines usually specify that drugs for external use should be kept in a separate cupboard from drugs for internal use. Controlled drugs, as specified in the regulations issued under the UK Misuse of Drugs Act 1971, must be kept in a separate cupboard. This must have a separate key, and this key must remain under the control of the nurse in charge of the ward at all times. A witnessed record must be kept of everything placed in, or taken from, this cupboard and any loss (e.g. due to breakage) should be accounted for. Medical and nursing staff must comply with identical rules in this regard.
Special considerations apply to the storage of vaccines. Many of these are damaged if they are not kept at between 4 and 8 °C at all times – even during transit and delivery (no mean feat in many resource poor or underdeveloped countries). A r