Effect of a Training Strategy in Improving Medication Fallacies During Pediatric Cardiopulmonary Resuscitation: A Before-and-After Study From a Developing Country

Abstract

Objective This study aims to evaluate the effect of structured training on resident performance in improving medication fallacies during pediatric cardiopulmonary resuscitation (CPR). Methods This before-and-after study was conducted in the pediatric acute care areas of tertiary care teaching hospitals of a developing country from August to December 2015. Case records of children younger than 18 years who underwent CPR were reviewed. Senior residents rotating through pediatric emergency department and pediatric intensive care unit were evaluated for their knowledge. Incidence of medication fallacies in pediatric CPR and change in the knowledge scores of residents posted in these areas were the main outcome measures. Results One-hundred records were evaluated (pre-intervention, 54; post-intervention, 46). In the pre-intervention period, 25 had medication fallacies (documentation, 16; dosing, 9). In the post-intervention period, 7 fallacies pertaining to documentation (not dosing) were found. The incidence of severe fallacies decreased from 20% pretraining to 0% posttraining. The mean (SD) knowledge scores of residents increased from 7.9 (2.9) pretraining to 13 (1.4) posttraining. On univariate analysis, fallacies were found to be less if the resident was formally trained (pediatric advanced life support certified), if the patient was older, and during morning and night shifts as compared with evening shift. On multivariate analysis, however, only status of training (posttraining) (adjusted odds ratio, 0.12; 95% confidence interval, 0.02–0.68) and the morning shift (adjusted odds ratio, 0.03; 95% confidence interval, 0.001–0.72) remained significant with lower incidence of fallacies associated with these variables. Conclusions Rates of medication fallacies in pediatric CPR declined with structured training. Documentation fallacies may not be eliminated completely with only 1-time training.

A narrative review of course evaluation methods for continuing professional development: The case of paediatric and neonatal acute-care in-service courses in low and lower-middle income countries: BEME Guide No. 76

“…Rural ETAT courses in Kenya, randomising hospitals to intensive or control training, performed a retrospective casenote review over 18 months regarding documentation of clinical signs and treatment as process indicators of change (Ayieko et al 2011). A two-day training in India on prescribing during paediatric cardiopulmonary resuscitation performed a pre-and post-course casenote review of medication 'fallacies' during CPR (Sankar et al 2019). Another course in India teaching about paediatric emergency referrals examined the quality of referral letters pre-and post-course (Ezhumalai et al 2020).…”