Comparison of Errors Using Two Length-Based Tape Systems for Prehospital Care in Children

Abstract

Background: The use of a length/weight-based tape (LBT) for equipment size and drug dosing for pediatric patients is recommended in a joint statement by multiple national organizations. A new system, known as Handtevy™, allows for rapid determination of critical drug doses without performing calculations. Objective: To compare two LBT systems for dosing errors and time to medication administration in simulated prehospital scenarios. Methods: This was a prospective randomized trial comparing the Broselow Pediatric Emergency Tape™ (Broselow) and Handtevy LBT™ (Handtevy). Paramedics performed 2 pediatric simulations: cardiac arrest with epinephrine administration and hypoglycemia mandating dextrose. Each scenario was repeated utilizing both systems with a 1 year-old and 5 year-old size manikin. Facilitators recorded identified errors and time points of critical actions including time to medication. Results: We enrolled 80 paramedics, performing 320 simulations. For Dextrose, there were significantly more errors with Broselow (63.8 %) compared to Handtevy (13.8%) and time to administration was longer with the Broselow system (220 seconds vs. 173 seconds). For epinephrine, the LBTs were similar in overall error rate (Broselow 21.3% vs. Handtevy 16.3%) and time to administration (89 vs. 91 seconds). Cognitive errors were more frequent when using the Broselow compared to Handtevy, particularly with dextrose administration. The frequency of procedural errors was similar between the two LBT systems. Conclusion: In simulated prehospital scenarios, use of the Handtevy LBT system resulted in fewer errors for dextrose administration compared to the Broselow LBT, with similar time to administration and accuracy of epinephrine administration.

Decreasing Prescribing Errors During Pediatric Emergencies: A Randomized Simulation Trial

“…28 However, a recent simulation study found a high rate of error by paramedics administering epinephrine according to 2 different length/weight-based tapes (Broselow, 21.3% vs Handtevy, 16.3%). 29 Pediatric epinephrine dosing in the prehospital setting is known to be error prone, even with standardization. 30,31 Computerized provider order entry (CPOE) with or without clinical decision support has been widely advocated for reducing prescribing errors.…”

Prehospital medical equipment for care of pediatric injury patients in Japanese ambulances: a nationwide survey

“…Previous studies have recommended a length-based tape to adjust equipment size for pediatric patients in prehospital settings. 9,12 The equipment required for prehospital care may vary according to the needs of the population being treated and training level of the ambulance crew who provides the care. Upper airway obstruction and hypoxia are major causes of death, and 0.7% of all pediatric injury patients transferred by ambulance have injury-related out-of-hospital cardiac arrest; thus, pediatric devices to maintain airway and ventilation are essential.…”

“…However, our study revealed that only 5% of the fire defense headquarters had the complete set of cuffs with appropriate sizes for children of all ages. Previous studies have recommended a length‐based tape to adjust equipment size for pediatric patients in prehospital settings 9,12 …”

Development and Prospective Federal State-Wide Evaluation of a Device for Height-Based Dose Recommendations in Prehospital Pediatric Emergencies: A Simple Tool to Prevent Most Severe Drug Errors

“…14 Nevertheless, such errors still occurred and difficulties in using this system have been described. 15 Since the BT was never sold 16 nor licensed as a medical product in Europe it was additionally unsuitable for its use in Europe. We therefore developed and introduced a certified and licensed length-based dosing recommendation system the "Pediatric emergency ruler" (PaedER; Alpha 1 e.K., Falkenberg, Germany) in 2008.…”