Improving Pediatric Drug Safety in Prehospital Emergency Care—10 Years on

Abstract

Objectives The Pediatric Emergency Ruler (PaedER) is a height-based drug dose recommendation tool that was reported to reduce life-threatening medication errors by 90%. The PaedER was introduced into the Cologne Emergency Medical Service (EMS) in 2008 along with educational measures, publications, and lectures for pediatric drug safety. We reviewed the impact of these continuously ongoing measures on medication errors after 10 years. Methods The PaedER was introduced and distributed to all 14 emergency ambulances and 2 helicopters staffed with emergency physicians in the city of Cologne in November 2008. Electronic records and medical protocols of the Cologne EMS over two 20-month periods from March 2007 to October 2008 and March 2018 to October 2019 data sets were retrieved. The administered doses of either intravenous, intraosseous, intranasal, or buccal fentanyl, midazolam, ketamine, or epinephrine were recorded. Primary outcome measure was the rate of severe drug dosing errors with a deviation from the recommended dose of greater than 300%. Results A total of 59 and 443 drug administrations were analyzed for 2007/08 and 2018/19, respectively. The overall rate of drug dosing errors decreased from 22.0% to 9.9% ( P = 0.014; relative risk reduction, 55%). Four of 5 severe dosing errors for epinephrine were avoided ( P < 0.021; relative risk reduction, 78%). Documentation of patient’s weight increased from 3.2% in 2007/08 to 30.5% in 2018/19 ( P < 0.001). Conclusions The distribution of the PaedER combined by educational measures significantly reduced the rates of life-threatening medication errors in a large EMS. Those results should motivate further initiatives on pediatric drug safety in prehospital emergency care.

Update Kinderreanimation – Neue ERC-Leitlinie

“…Und alleine in der Erhöhung der Vigilanz, also in dem Erkennen der Bedeutsamkeit der Medikationssicherheit und der eigenen Fehlbarkeit, liegen die wichtigsten Voraussetzungen für eine Verbesserung. In einer deutschen Großstadt hatte ein Paket verschiedener Maßnahmen zur Verbesserung der Medikamentensicherheit bei Kindern die Rate an schwerwiegenden Dosierungsfehlern mehr als halbiert, bezüglich des Adrenalins zur Reanimation oder Anaphylaxie sogar um fast 80% reduziert [19]. Dadurch wird deutlich, dass es sich lohnt, sich diesbezüglich zu engagieren, und einfach umzusetzende Maßnahmen können die Medikamentensicherheit bei Kindernotfällen erheblich verbessern.…”

The German guidelines for medication safety in pediatric emergencies

“…However, other simple measures that reduce the cognitive requirements by supporting or replacing calculations (like the "Pediatric Emergency Ruler") are also effective to reduce the frequency and the severity of such errors. 8,12,17,19…”

“…This was rectified along with other measures 10 years ago, when the documentation rate rose to 30% with an overall reduction of severe dosing errors by 55% and by 78% for epinephrine. 19 Parental reported weight should be used, otherwise, height-related estimations are better than age-related estimations 20 with appropriate systems available. 6 Obesity can cause drug overdose if the total body weight is used for drug calculations.…”

“…The individual weight‐related calculation is the most error‐prone step during emergency medication administration and may lead to harm. However, other simple measures that reduce the cognitive requirements by supporting or replacing calculations (like the “Pediatric Emergency Ruler”) are also effective to reduce the frequency and the severity of such errors 8,12,17,19 NOTE Potentially harmful medications must never be given without prior verification by a cognitive aid.…”

“…This was partially due to the fact that, until recently, the nationwide emergency physician protocols did not universally offer an entry field to document the body weight. This was rectified along with other measures 10 years ago, when the documentation rate rose to 30% with an overall reduction of severe dosing errors by 55% and by 78% for epinephrine 19 NOTE Actual or height‐related estimation of the body weight is critical for medication safety in pediatric emergencies.…”