Effect of a Mobile App on Prehospital Medication Errors During Simulated Pediatric Resuscitation

Abstract

IMPORTANCE Medication errors are a leading cause of injury and avoidable harm, affecting millions of people worldwide each year. Children are particularly susceptible to medication errors, but innovative interventions for the prevention of these errors in prehospital emergency care are lacking. OBJECTIVE To assess the efficacy of an evidence-based mobile app in reducing the occurrence of medication errors compared with conventional preparation methods during simulated pediatric out-of-hospital cardiac arrest scenarios. DESIGN, SETTING, AND PARTICIPANTS This nationwide, open-label, multicenter, randomized clinical trial was conducted at 14 emergency medical services centers in Switzerland from September 3, 2019, to January 21, 2020. The participants were 150 advanced paramedics with drug preparation autonomy. Each participant was exposed to a 20-minute, standardized, fully video-recorded, realistic pediatric out-of-hospital cardiac arrest cardiopulmonary resuscitation scenario concerning an 18-month-old child. Participants were tested on sequential preparations of 4 intravenous emergency drugs of varying degrees of preparation difficulty (epinephrine, midazolam, 10% dextrose, and sodium bicarbonate). INTERVENTION Participants were randomized (1:1 ratio) to the support of an app designed to assist with pediatric drug preparation (intervention; n = 74) or to follow conventional drug preparation methods without assistance (control; n = 76). MAIN OUTCOMES AND MEASURESThe primary outcome was the rate of medication errors, defined as a failure in drug preparation according to predefined, expert consensus-based criteria.Logistic regression models with mixed effects were used to assess the effect of the app on binary outcomes. Secondary outcomes included times to drug preparation and delivery, assessed with linear regression models with mixed effects. RESULTSIn total, 150 advanced paramedics (mean [SD] age, 35.6 [7.2] years; 101 men [67.3%];mean [SD] time since paramedic certification, 8.0 [6.2] years) participated in the study and completed 600 drug preparations. Of 304 preparations delivered using the conventional method, 191 (62.8%; 95% CI, 57.1%-68.3%) were associated with medication errors compared with 17 of 296 preparations delivered using the app (5.7%; 95% CI, 3.4%-9.0%). When accounting for repeated measures, with the app, the proportion of medication errors decreased in absolute terms by 66.5% (95% CI, 32.6%-83.8%; P < .001), the mean time to drug preparation decreased by 40 seconds (95% CI, 23-57 seconds; P < .001), and the mean time to drug delivery decreased by 47 seconds (95% CI, (continued) Key Points Question Does the use of an evidencebased, custom-designed, mobile app result in decreased rates of pediatric medication errors compared with conventional preparation methods in prehospital emergency care? Findings In this multicenter, simulationbased, randomized clinical trial including 150 advanced paramedics in 14 emergency medical services centers and 600 drug preparations, the proportion of medication er...

Impact of a Mobile App on Paramedics’ Perceived and Physiologic Stress Response During Simulated Prehospital Pediatric Cardiopulmonary Resuscitation: Study Nested Within a Multicenter Randomized Controlled Trial

“…No dropouts occurred ( Figure 3 ). The baseline characteristics are detailed in the published parent trial [ 38 ]. They were balanced in the 2 groups, and recruitment was balanced across the centers.…”

“…This study was registered at ClinicalTrials.gov (NCT03921346) as a nested study within the context of an open-label, multicenter, randomized controlled trial. The parent trial had the broader and primary aim of assessing rates of medication dosing errors during simulation-based pediatric OHCA scenarios using a high-fidelity manikin [ 38 ]. The trial protocol, containing details about the scenario, has been previously published [ 39 ].…”

“…The participants were asked to sequentially prepare and inject 4 different direct intravenous drugs of various degrees of preparation difficulties (epinephrine, midazolam, dextrose 10%, and sodium bicarbonate), either with the support of the app or following conventional methods (ie, without app support). Full details of the intervention and scenario have been previously published [ 38 ]. During the timed scenario, the resuscitation team maintained a stressful and realistic resuscitation atmosphere by frequently reporting vital signs aloud and asking the participant to promptly provide the drugs.…”

“…This app provided an exhaustive and editable list of intravenous drugs, either for direct injections or continuous infusions [ 37 , 38 , 42 ]. The drugs were displayed in alphabetical order with doses automatically adapted to the weight or age of the patient.…”

“…Although similarities exist, the prehospital environment is distinctly different in many regards. Recent findings of a multicenter randomized trial showed that this app was also able to reduce medication error rates during pediatrics OHCA in a simulated model [ 38 ]. However, its impact on situational stress experienced by paramedics during CPR remains to be determined.…”