Effect of an intervention standardization system on pediatric dosing and equipment size determination: a crossover trial involving simulated resuscitation events.

BACKGROUND Pediatric medication dosing has been recognized as a high-error activity with the potential to cause serious harm. Few studies assess systems approaches to error reduction in pediatrics. OBJECTIVE To estimate the decrease in deviation from recommended medication doses associated with use of a pediatric intervention standardization system in the acute setting. DESIGN Two-period, 2-treatment crossover trial with data collected between December 1, 1999, and February 29, 2000. SETTING Tertiary, academic medical center. PARTICIPANTS Convenience sample of 28 resident physicians, representing 69% of pediatrics and 50% of medicine-pediatrics residents. INTERVENTION Each resident participated in 4 simulated pediatric resuscitations. The Broselow Pediatric Emergency Tape and color-coded materials were available in either the first or second 2 scenarios. Traditional dosing references were available in all scenarios. MAIN OUTCOME MEASURE Median difference between deviation from recommended dose range (DRDR) in scenarios where color coding was used (intervention) and DRDR in scenarios where color coding was not available (control). RESULTS Median DRDR in intervention scenarios was 25.4% lower than in control scenarios (95% confidence interval [CI], 19.1%-32.5%; P<.001). In 4 medication prescriptions in intervention scenarios and in 54 prescriptions in control scenarios, DRDRs exceeded 100%. Median deviation from recommended equipment sizes in intervention scenarios was 0.12 size lower than in control scenarios (95% CI, 0.03-0.22 size; P<.001). Deviations in equipment size of 2 or more sizes were noted in 1 size determination in intervention scenarios and in 21 size determinations in control scenarios. CONCLUSIONS Color coding was associated with a significant reduction in deviation from recommended doses in simulated pediatric emergencies. Numerous potentially clinically significant deviations from recommended doses and equipment sizes were avoided. Future studies should measure impact in the real clinical setting.

[1]  Donald P Frush,et al.  Improved pediatric multidetector body CT using a size-based color-coded format. , 2002, AJR. American journal of roentgenology.

[2]  C. Gunn,et al.  The Harriet Lane Handbook , 2002 .

[3]  T. Chan,et al.  Estimation of pediatric patient weight by EMT-PS. , 2001, The Journal of emergency medicine.

[4]  D. Bates,et al.  Medication errors and adverse drug events in pediatric inpatients. , 2001, JAMA.

[5]  T. Brennan,et al.  Incidence and types of adverse events and negligent care in Utah and Colorado. , 2000, Medical care.

[6]  D. Bates,et al.  Pharmacist participation on physician rounds and adverse drug events in the intensive care unit. , 1999, JAMA.

[7]  J. Patterson,et al.  Doctors, nurses, and parents are equally poor at estimating pediatric weights. , 1999, Pediatric emergency care.

[8]  D. Bates,et al.  Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. , 1998, JAMA.

[9]  G Koren,et al.  Errors by paediatric residents in calculating drug doses , 1998, Archives of disease in childhood.

[10]  D. Ririe,et al.  Pediatric endotracheal tube selection: a comparison of age-based and height-based criteria. , 1998, AANA journal.

[11]  T S Lesar,et al.  Errors in the use of medication dosage equations. , 1998, Archives of pediatrics & adolescent medicine.

[12]  T. Clemmer,et al.  A computer-assisted management program for antibiotics and other antiinfective agents. , 1998, The New England journal of medicine.

[13]  H Pohl,et al.  Medication-prescribing errors in a teaching hospital. A 9-year experience. , 1997, Archives of internal medicine.

[14]  D S Stein,et al.  Factors related to errors in medication prescribing. , 1997, JAMA.

[15]  Edward J. Otten,et al.  Emergency medicine: A comprehensive study guide (4th ed) , 1996 .

[16]  M. Potts,et al.  Deficiencies in calculation and applied mathematics skills in pediatrics among primary care interns. , 1996, Archives of pediatrics & adolescent medicine.

[17]  N. Dickey,et al.  Systems analysis of adverse drug events. , 1996, JAMA.

[18]  E. Ruiz,et al.  Emergency Medicine: A Comprehensive Study Guide , 1996 .

[19]  N. Laird,et al.  Incidence of Adverse Drug Events and Potential Adverse Drug Events: Implications for Prevention , 1995 .

[20]  D. Bates,et al.  Systems analysis of adverse drug events. ADE Prevention Study Group. , 1995, JAMA.

[21]  K. B. Johnson,et al.  The Harriet Lane Handbook , 1994 .

[22]  R. Mauro.  Pediatric emergency medicine: Concepts and clinical practice , 1993 .

[23]  R. Wears,et al.  Length-based endotracheal tube and emergency equipment in pediatrics. , 1992, Annals of emergency medicine.

[24]  T. Brennan,et al.  The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II. , 1991, The New England journal of medicine.

[25]  T. Brennan,et al.  INCIDENCE OF ADVERSE EVENTS AND NEGLIGENCE IN HOSPITALIZED PATIENTS , 2008 .

[26]  A. Zaritsky,et al.  A rapid method for estimating weight and resuscitation drug dosages from length in the pediatric age group. , 1988, Annals of emergency medicine.

[27]  J C Russo,et al.  Medication error prevention by clinical pharmacists in two children's hospitals. , 1987, Pediatrics.

[28]  G Koren,et al.  Tenfold errors in administration of drug doses: a neglected iatrogenic disease in pediatrics. , 1986, Pediatrics.

[29]  P. Perlstein,et al.  Errors in drug computations during newborn intensive care. , 1979, American journal of diseases of children.

[30]  M. McDonough,et al.  Stresses affecting surgical performance and learning. I. Correlation of heart rate, electrocardiogram, and operation simultaneously recorded on videotapes. , 1972, The Journal of surgical research.