Medication safety: Best practice for effective paediatric ward rounds - clinical practice guideline

Published in December 2023, this clinical practice guideline developed by RCPCH and the Neonatal and Paediatric Pharmacy Group Joint Standing Committee on Medicines (RCPCH-NPPG), covers the inclusion of medication analysis in the paediatric ward round environment to improve medication safety.
RCPCH Royal College of Paediatrics and Child Health | Leading the way in children's health
NPPG - Neonatal & Paediatric Pharmacy Group

This report is a response to an investigation a response to a national investigation into weight base medications errors in children that was carried out by the Healthcare Safety Investigation Branch (HSIB) in 2022.

This report investigated the case of unintentional repeated tenfold overdoses with dalteparin in a four-year-old child who suffered neurological harm and to prevent future errors HSIB recommenced the RCPCH to identify best practice principles for effective paediatric ward rounds in relation to medications and disseminates them to its members.

The guideline supplements and should be used in conjunction with:

  • The NICE guideline on Medicines optimisation: the safe and effective use of medicines to enable the best possible outcomes [NG5].
  • The NICE guideline on Medicines adherence: involving patients in decisions about prescribed medicines and supporting adherence [CG76].
  • The Royal College of Physicians (RCP) guideline on Best practice principles of the modern ward environment [RCP guide]

This guideline is aimed at healthcare professionals caring for paediatric inpatients, commissioners and providers as well as children and young people and their families admitted to an inpatient environment.


This best practice guideline has been developed as a result of the recommendations by the Healthcare Safety Investigation Branch’s (HSIB) report ’Weight-based medication errors in children’.

A Task & Finish Group was established with select members of the cross-organisational Medicines Committee, which is overseen by the RCPCH and has representation from across the child health and medicines community, including the Neonatal and Paediatric Pharmacists group, RCPCH, NHS England / NHS Improvement, Royal Pharmaceutical Society, the British National Formulary for Children and the Medicines and Healthcare products Regulatory Agency.

A systematic review identified low evidence on best practice for paediatric ward rounds in relation to medicines. Consensus was reached on practice recommendations through a robust Delphi process which was achieved across all paediatric specialties, parents/carers and the wider multi-disciplinary team.