Quality standard
Quality statement 8: Domperidone, metoclopramide and erythromycin
Quality statement 8: Domperidone, metoclopramide and erythromycin
Quality statement
Infants, children and young people are not prescribed domperidone, metoclopramide or erythromycin to manage gastro‑oesophageal reflux (GOR) or gastro‑oesophageal reflux disease (GORD) without specialist paediatric advice.
Rationale
Prokinetics such as domperidone and metoclopramide are associated with a range of risks such as neurological and cardiac adverse events. Domperidone, metoclopramide and erythromycin (which is used in GOR and GORD for its prokinetic properties) should only be prescribed for infants, children and young people if there is an agreement for its use by a specialist paediatric healthcare professional.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Structure
Evidence of local arrangements to ensure that infants, children and young people are not prescribed domperidone, metoclopramide or erythromycin to manage GOR or GORD without specialist paediatric advice.
Data source: Local data collection.
Process
Proportion of infants, children and young people prescribed domperidone, metoclopramide or erythromycin to manage GOR or GORD on the basis of specialist paediatric advice.
Numerator – number in the denominator who were prescribed domperidone, metoclopramide or erythromycin on the basis of specialist paediatric advice.
Denominator – number of infants, children and young people prescribed domperidone, metoclopramide or erythromycin to manage GOR or GORD.
Data source: Local data collection.
What the quality statement means for different audiences
Service providers (secondary care, community care providers, GP practices) ensure that there are practice arrangements and written clinical protocols to ensure that infants, children and young people are not prescribed domperidone, metoclopramide or erythromycin to manage GOR or GORD without specialist paediatric advice.
Healthcare professionals (midwives, paediatric nurses or GPs) do not prescribe domperidone, metoclopramide or erythromycin to manage GOR or GORD in infants, children and young people without specialist paediatric advice.
Commissioners (clinical commissioning groups and NHS England) ensure that services they commission do not prescribe domperidone, metoclopramide or erythromycin to manage GOR or GORD in infants, children and young people without specialist paediatric advice.
Infants, children and young people are not prescribed medicines called domperidone, metoclopramide or erythromycin to manage reflux unless a specialist advises it.
Source guidance
Gastro-oesophageal reflux disease in children and young people. NICE guideline NG1 (2015, updated 2019), recommendation 1.3.7 (key priority for implementation)
Definitions of terms used in this quality statement
Specialist
Specialist refers to a paediatrician with the skills, experience and competency necessary to deal with the particular clinical concern that has been identified by the referring healthcare professional. In this guidance this is most likely to be a consultant general paediatrician. Depending on the clinical circumstances, 'specialist' may also refer to a paediatric surgeon, paediatric gastroenterologist or a doctor with the equivalent skills and competency. [NICE's guideline on gastro-oesophageal reflux disease in children and young people, definitions section]