Evelina London reduces ‘a spoonful of medicine’ with pill school

The pharmacy team at Evelina London Children’s Hospital has launched a ‘pill school’ helping children to swap liquid medication for tablets.

One of the first in London, the pill school will support children across the inpatient wards and outpatient departments of the specialist children’s hospital.

Swapping liquid medication to tablets has many benefits. Tablets are easier to transport and store, and reduce the risk of dosage error. They are also cheaper to buy, reducing the cost for both the family and the Trust.

Helping to train children and young people to take tablets instead of liquids, the pill school will offer patients different methods to successfully swallow tablets in a safe, controlled environment.

Children are given a range of small sweets to swallow with either water, juice or soft food, like a yoghurt. A range of cups and bottles are used.

Dr Asia Rashed, pharmacy project manager at Evelina London Children’s Hospital, said: “We start children off using a small hard sweet approximately 3mm wide, and slowly increase the size to be approximately the same as the tablet, normally about 1cm to 1.5cm. Children will swallow food bigger than these sizes, so the training provides tips on how to angle their head and to provide reassurance.”

James Nichols, aged 8, from Kent, took part in a pilot study for the pill school when he was an in-patient at Evelina London.

James’ mum, Samantha Nichols, said: “James was 5 years old when he completed the training, and successfully swapped from having liquid medicine to taking tablets. It’s made a huge difference. James had a kidney transplant when he was 5, so will be on medication for his whole life – including taking many tablets daily. Every morning, James needs to take a number of different drugs to protect his kidney, and being able to take them in the tablet form has made things so much easier. As the dose of his medication meant that he was having to drink quite a lot of liquid medicine, which was not pleasant!

“It also means at the start of every week, I can organise his tablets into blister packs so they’re all ready for the week ahead. This makes it much safer for him to take.”

James said: “I find it easier taking tablets now. It was horrible before because I had lots of liquid medicine to take and they didn’t taste nice!”

In a feasibility study conducted at Evelina London in 2019 involving 30 children aged between 3 to 14 years, 26 successfully completed a single-short session of the pill school having learnt how to take tablets. 24 of those patients went on to be discharged from the hospital with tablets instead of oral liquid medication.

Dr Asia Rashed continued: “It was great to see that the majority of children who took part in the study were able to swap to taking tablets. Taking tablets instead of liquid medicine has lots of benefits for the patient and the family.

“For example, liquid medicines often don’t taste nice which reduces the chances of children taking the medicine accurately. Tablets can also reduce medication error as the dose is pre-measured, compared to pouring out a liquid. Tablets are also easier to store and transport, making it easier for families to carry important medication when out and about.

“There is also a cost implication for families and the Trust. Many of our patients will need to be on medication for long periods of time, so being able to take tablets will help prepare them to move from children’s to adult services as they can take charge of their own medication. Tablets are also a lot cheaper than liquid medicine so it can help save families money.”

The feasibility study found that if the 24 patients discharged from care with tablet medication were to continue being prescribed tablets for a year, it would save the Trust £30,000.

During the feasibility study, the youngest patient to be discharged from the pill school was three and a half years old.

Involving children and young people in research studies while they’re receiving treatment in hospital, is vital in improving patient care. Evelina London has an unparalleled depth of clinical and research expertise in children’s services across the region.