Decreasing Prescribing Errors During Pediatric Emergencies: A Randomized Simulation Trial

Larose, Gabriel; Lévy, Arielle; Bailey, Benoît; Cummins-McManus, Barbara; Lebel, Denis; Gravel, Jocelyn

doi:10.1542/peds.2016-3200

Cited by 15 publications

(20 citation statements)

References 36 publications

(24 reference statements)

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“…Multiple studies identify this as a major area where medication errors can occur, and a major contributor to pediatric morbidity and mortality . The weighing of patients only in kilograms is an important safety procedure and many professional organizations including the AAP, ENA, and the Joint Commission have identified this as a national initiative …”

Section: Discussionmentioning

confidence: 99%

“…[34][35][36][37][38][39] The weighing of patients only in kilograms is an important safety procedure and many professional organizations including the AAP, ENA, and the Joint Commission have identified this as a national initiative. 40,41 Considering pediatricians and pediatric emergency medicine physicians accounted for less than 10% of staffing in facilities with no significant difference by volume, facilities need systems in place to facilitate identification of ill children. Only 38% of facilities had triage policies that addressed children, and approximately 60% had written policies to notify a physician of abnormal vitals or policies for assessment and reassessment of the patient.…”

Section: Discussionmentioning

confidence: 99%

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Pediatric Readiness in Critical Access Hospital Emergency Departments

Pilkey

Edwards

Richards

et al. 2018

The Journal of Rural Health

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pediatric Readiness in Critical Access Hospital Emergency Departments

Pilkey

Edwards

Richards

et al. 2018

The Journal of Rural Health

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“…In a recent randomized trial in a pediatric ED, the use of a reference book providing weight-based precalculated doses was associated with a lower proportion of prescribing errors for drugs administered by infusion [ 27 ]. The study, however, didn’t look at the preparation errors.…”

Section: Discussionmentioning

confidence: 99%

A Mobile Device App to Reduce Medication Errors and Time to Drug Delivery During Pediatric Cardiopulmonary Resuscitation: Study Protocol of a Multicenter Randomized Controlled Crossover Trial

Siebert¹,

Ehrler²,

Lovis³

et al. 2017

JMIR Res Protoc

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BackgroundDuring pediatric cardiopulmonary resuscitation (CPR), vasoactive drug preparation for continuous infusions is complex and time-consuming. The need for individual specific weight-based drug dose calculation and preparation places children at higher risk than adults for medication errors. Following an evidence-based and ergonomic driven approach, we developed a mobile device app called Pediatric Accurate Medication in Emergency Situations (PedAMINES), intended to guide caregivers step-by-step from preparation to delivery of drugs requiring continuous infusion. In a prior single center randomized controlled trial, medication errors were reduced from 70% to 0% by using PedAMINES when compared with conventional preparation methods.ObjectiveThe purpose of this study is to determine whether the use of PedAMINES in both university and smaller hospitals reduces medication dosage errors (primary outcome), time to drug preparation (TDP), and time to drug delivery (TDD) (secondary outcomes) during pediatric CPR when compared with conventional preparation methods.MethodsThis is a multicenter, prospective, randomized controlled crossover trial with 2 parallel groups comparing PedAMINES with a conventional and internationally used drug infusion rate table in the preparation of continuous drug infusion. The evaluation setting uses a simulation-based pediatric CPR cardiac arrest scenario with a high-fidelity manikin. The study involving 120 certified nurses (sample size) will take place in the resuscitation rooms of 3 tertiary pediatric emergency departments and 3 smaller hospitals. After epinephrine-induced return of spontaneous circulation, nurses will be asked to prepare a continuous infusion of dopamine using either PedAMINES (intervention group) or the infusion table (control group) and then prepare a continuous infusion of norepinephrine by crossing the procedure. The primary outcome is the medication dosage error rate. The secondary outcome is the time in seconds elapsed since the oral prescription by the physician to drug delivery by the nurse in each allocation group. TDD includes TDP. Stress level during the resuscitation scenario will be assessed for each participant by questionnaire and recorded by the heart rate monitor of a fitness watch. The study is formatted according to the Consolidated Standards of Reporting Trials Statement for Randomized Controlled Trials of Electronic and Mobile Health Applications and Online TeleHealth (CONSORT-EHEALTH) and the Reporting Guidelines for Health Care Simulation Research.ResultsEnrollment and data analysis started in March 2017. We anticipate the intervention will be completed in late 2017, and study results will be submitted in early 2018 for publication expected in mid-2018. Results will be reported in line with recommendations from CONSORT-EHEALTH and the Reporting Guidelines for Health Care Simulation Research .ConclusionsThis paper describes the protocol used for a clinical trial assessing the impact of a mobile device app to reduce the rate of medication errors,...

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“…Another study done in the U.S. over one year on 18 pediatric EDs has also shown that the most commonly reported ME were antiinfective agents and analgesics, followed by other medications such as intravenous fluids and respiratory medications [25]. Therefore, clinical aid solutions to assist prescribers with medication prescription (e.g., dose calculators and clinical pharmacists involvement in ED for pediatric patients in the ED) need to be investigated and considered [26].…”

Section: Plos Onementioning

confidence: 99%

Prescribing errors and associated factors in discharge prescriptions in the emergency department: A prospective cross-sectional study

et al. 2021

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Objectives Evidence regarding the prevalence of medication prescribing errors (PEs) and potential factors that increase PEs among patients treated in the emergency department (ED) are limited. This study aimed to explore the prevalence and nature of PEs in discharge prescriptions in the ED and identify potential risk factors associated with PEs. Methods This was a prospective observational cross-sectional study in an ambulatory ED in a tertiary teaching hospital. Data were collected for six months using a customized reporting tool. All patients discharged from ED with a discharged prescription within the study period were enrolled in this study. Results About 13.5% (n = 68) of the 504 prescriptions reviewed (for 504 patients) had at least one error. Main PEs encountered were wrong dose (23.2%), wrong frequency (20.7%), and wrong strength errors (14.6%). About 36.8% of identified PEs were related to pediatric prescriptions, followed by the acute care emergency unit (26.5%) and the triage emergency unit (20.6%). The main leading human-related causes associated with PEs were lack of knowledge (40.9%) followed by an improper selection from a computer operator list (31.8%). The leading contributing systems related factors were pre-printed medication orders (50%), lack of training (31.5%), noise level (13.0%), and frequent interruption of prescriber and distraction (11.1%). Prescribers' involved with the identified errors were resident physicians (39.4%), specialists (30.3%), and (24.4%) were made by general practitioners. Physicians rejected around 12% of the pharmacist-raised recommendations related to the identified PEs as per their clinical judgment. Conclusion PEs in ED setting are common, and multiple human and systems-related factors may contribute to the development of PEs. Further training to residents and proper communication between the healthcare professionals may reduce the risk of PEs in ED.

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Decreasing Prescribing Errors During Pediatric Emergencies: A Randomized Simulation Trial

Abstract: A clinical aid providing precalculated medication doses was not associated with a decrease in overall prescribing error rates but was highly associated with a lower risk of 10-fold error for bolus medications and for medications administered by continuous infusion.

Cited by 15 publications

References 36 publications

Pediatric Readiness in Critical Access Hospital Emergency Departments

Pediatric Readiness in Critical Access Hospital Emergency Departments

A Mobile Device App to Reduce Medication Errors and Time to Drug Delivery During Pediatric Cardiopulmonary Resuscitation: Study Protocol of a Multicenter Randomized Controlled Crossover Trial

Prescribing errors and associated factors in discharge prescriptions in the emergency department: A prospective cross-sectional study

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