Paramedic Pediatric Medication Errors and High Reliability Solutions
UCLA Prehospital Care Research Forum
Paramedic Pediatric Medication Errors and High Reliability Solutions
Abstract #: EMS16-04
Authors:
| Michael S. Wallace,
BSHS, CCPM, NRP Co-Investigator Tennessee EMS for Children Committee on Pediatric Emergency Care |
Donna Tidwell, BS,
RN, PM Co-Investigator Tennessee Department of Health - Division of EMS |
Eric Powell,
Ph.D.,NRP Study Director Walters Staet Community Collage Morristown, TN |
Background:
Reducing pediatric medication errors made by paramedics working under time
sensitive and stressful circumstances is an on-going challenge. Various
strategies have demonstrated positive results though serious mistakes still
prevail. One method that offers immediate substantial improvement is to
completely eliminate math and provide clinicians with the exact answers they
need at the point of care.
Objective:
To demonstrate paramedic potential for pediatric medication calculation errors
and a method for improving performance by providing the answers to each possible
equation.
Methods:
This quantitative research project was designed to study errors made determining
weight-based pediatric drug doses by currently practicing paramedics with at
least 2 years of experience. We defined a dosing error as >20% deviation from
the precise weight-based calculation or Broselow™ Pediatric Emergency Tape
equivalent. Clinicians were placed in a timed testing environment and challenged
to determine doses in milligrams (mg), milliliters (ml) and physically
demonstrate the correct (ml) with a syringe. Five different medications commonly
used were chosen: epinephrine 1:10,000 for cardiac arrest, epinephrine 1:1000
for anaphylaxis, Dextrose 25% for hypoglycemia, magnesium sulfate for asthma and
adenosine for SVT.
Results:
·
114 participants averaging
14.3 years of experience practicing at the paramedic level representing all
eight Tennessee geographic EMS regions, completed the study.
·
Phase one presented a patient
weighing 9 kg and provided a Broselow™ Tape, pen, paper and a calculator if
desired. Results:
o
81% accurate determination of
dose weight value (mg)
o
35% accurate determination of
volume (ml)
o
37% accurate demonstration of
volume (ml) in a syringe
·
Phase two presented a patient
weighing 22 kg and provided clinicians with RightDose© pre-calculated pediatric
dosing charts for each medication regimen. Overall test results:
o
96% accurate determination of
dose weight value (mg)
o
96% accurate determination of
volume (ml)
o
93% accurate demonstration of
volume (ml) in a syringe
o
Overall combined accuracy was
94% with a 1% over-dose error rate and a 5% under-dose error rate.
·
Conclusions. Eliminating math
and providing an easy to use resource with the exact answers for each possible
calculation demonstrated significant improvements in accuracy over currently
utilized resources and practices.
