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Referral pathways should be available to a paediatric psychology service.²⁶

Blood transfusion and diagnostic services should meet the requirements of neonates, infants, and children. A massive transfusion protocol, including provision for children, should be in place.

There should be pharmacy staff available with clinical knowledge appropriate to the local paediatric case mix to provide advice on the management of drugs in children.

There should be awareness that the paediatric population is at greater risk of drug errors. Local systems and training in human factors should be in place to minimise and report prescription and drug administration errors.^27,28

There should be local systems in place to disseminate national safety alerts.

There should be access to the British National Formulary for Children online and in all areas where children are cared for.²⁹

There should be a fully resourced children’s inpatient pain service.^30,31 The service should be delivered by an appropriately trained and experienced multidisciplinary team (MDT), with specific skills in children’s pain management. The team may include clinical nurse specialists, anaesthetists, paediatricians, surgeons, pharmacists, child psychologists and physiotherapists. In hospitals with a smaller paediatric caseload, and non-complex surgical...

There should be a named paediatric pain management lead. This may be from the anaesthetic team or from an allied specialty.

Analgesia guidance appropriate for children should be readily available. This should include training in and the use of pain assessment using age-appropriate validated tools, prescribing of analgesics and where appropriate guidelines on the use of complex analgesic techniques such as nurse and patient controlled analgesia, epidural analgesia, peripheral nerve local anaesthetic catheters.^31,32 Regional operational delivery networks...

All specialist tertiary paediatric centres should have access to paediatric chronic pain services to assist in managing complex cases. Other centres should develop a network to provide access to paediatric chronic pain services for advice and guidance.