Progression of indicators through the Delphi process
| Indicator | Round 1 Median IQR | Outcome | Revised indicator | Round 2 Median IQR | Outcome | |
|---|---|---|---|---|---|---|
| 1 | Systemic antihistamines should not be prescribed to children under 1 year. | 3 (2.5–4) | Revision required | Sedating antihistamines should not be prescribed to children under 2 years | 4 (4–4) | Accepted |
| 2 | Intranasal beclometasone should not be prescribed to children under 6 years | 4 (4–4) | Accepted | NA | NA | Accepted |
| 3 | Mucolytics should not be prescribed to children under 2 years | 4 (3.5–5) | Revision required | Carbocysteine should not be prescribed to children | 4 (4–5) | Accepted |
| 4 | An inhaled SABA should be prescribed to all children who are prescribed two or more inhaled corticosteroids for presumed asthma | 5 (4–5) | Accepted | NA | NA | Accepted |
| 5 | An inhaled SABA should be prescribed to children under 5 years who are also taking a leukotriene receptor antagonist for presumed asthma. | 5 (4–5) | Accepted | NA | NA | Accepted |
| 6 | An inhaled corticosteroid should be prescribed to children aged 5–15 years who are taking a LABA | 5 (4–5) | Accepted | NA | NA | Accepted |
| 7 | LABAs should not be prescribed to children under 5 years. | 4 (3.5–4) | Revision required | LABA's (either in combination or on their own) should not be prescribed to children under 5 years. New evidence presented | 4 (3.5–4) | Rejected based on lack of consensus of Delphi panel |
| 8 | Children under 12 years who are prescribed a pressurised metered-dose inhaler (pMDI) should also be prescribed a spacer device at least every 12 months. | 4 (4–5) | Accepted | NA | Accepted | |
| 9 | Loperamide should not be used in the treatment of diarrhoea in children under 4 years. | 4 (3.5–5) | Revision required | Loperamide should not be prescribed to children under 4 years. New evidence presented. | 4 (4–5) | Accepted |
| 10 | Domperidone should not be prescribed to children under 1 year, and for children over 1 year, it should not be prescribed for >7 days. | <1 year 5 (3.25–5) <7 days 4.6 (3.25–5) | Revision required | Rejected based on comments of panel. Lack of evidence to support. | NA | Rejected |
| 11 | Domperidone should not be prescribed concomitantly with erythromycin. | 4 (4–5) | Accepted | NA | NA | Accepted |
| 12 | Codeine/dihydrocodeine medications should not be prescribed to children under 12 years. | 4 (4–5) | Accepted | NA | NA | Accepted |
| 13 | Systemic corticosteroids should not be prescribed to children aged 5–15 years without evidence of asthma. | 3 (2.5–4) | Revision required | Other than in children with asthma, systemic corticosteroids should not be prescribed to children aged 5–15 years. | 4 (2–4) | Rejected- lack of consensus of Delphi panel. |
| 14 | An emollient should be prescribed to children who are prescribed more than one topical corticosteroid in a year. | 4 (4–5) | Accepted | NA | NA | Accepted |
| 15 | Very potent or potent topical corticosteroids, for example, clobetasol propionate should not be prescribed to children under 1 year. | 4 (3–4) | Revision required | Rejected by project steering group on the basis that clinical information is required | NA | Rejected |
| 16 | Tetracyclines should not be prescribed to children under 12 years. | 5 (4–5) | Accepted | NA | NA | Accepted |
Following a two-round Delphi process, the final list of indicators consisted of 12 indicators by system: respiratory n=6, gastrointestinal n=2, dermatological n=2, neurological n=2. Table 3 summarises the accepted indicators. Online supplementary file 4 details the PIPc indicators with supporting references.
LABA, long-acting β-2 agonist; NA, not applicable; PIPc, potentially inappropriate prescribing in children; pMDI, pressurised metered-dose inhaler; SABA, short-acting β-2 agonist.