Medication Dosing Safety for Pediatric Patients: Recognizing Gaps, Safety Threats, and Best Practices in the Emergency Medical Services Setting. A Position Statement and Resource Document from NAEMSP

Cicero, Mark X.; Adelgais, Kathleen; Hoyle, John D.; Lyng, John; Harris, Matthew; Moore, Brian R.; Gausche‐Hill, Marianne

doi:10.1080/10903127.2020.1794085

Cited by 20 publications

(7 citation statements)

References 75 publications

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“…In this study, weight-based medications were only given in 4.3% of EMS runs, very similar to the rate reported by Rappaport, et al (4.9%) 22. This rarity in itself is a risk factor for dosing errors 5. Limitations A major limitation of this study is that the determination of prehospital weight estimation method was based entirely on EMS provider policy.…”

supporting

confidence: 68%

“…5 Many tools have been developed to assist with pediatric weight estimation, including age-based formulas, length-based tapes, paperboard dosing wheels, and electronic applications. 5 The Broselow method, which provides a weight estimation based on length as measured using the Broselow tape, is the most commonly used length-based tape. The Broselow method was developed in the 1980s and has been modified and studied fairly extensively in the intervening years, with varying results.…”

Section: Introductionmentioning

confidence: 99%

“…However, in prehospital care, obtaining reliable weight measurements is not straightforward; it is estimated that approximately 20% of out-of-hospital pediatric weight estimates are not accurate. 5 Many tools have been developed to assist with pediatric weight estimation, including age-based formulas, length-based tapes, paperboard dosing wheels, and electronic applications. 5 The Broselow method, which provides a weight estimation based on length as measured using the Broselow tape, is the most commonly used length-based tape.…”

Section: Introductionmentioning

confidence: 99%

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Weighty Matters: A Real-World Comparison of the Handtevy and Broselow Methods of Prehospital Weight Estimation

Knudsen-Robbins

Pham

Zaky

et al. 2022

Prehosp. Disaster med.

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Introduction:The majority of pediatric medications are dosed according to weight and therefore accurate weight assessment is essential. However, this can be difficult in the unpredictable and peripatetic prehospital care setting, and medication errors are common. The Handtevy method and the Broselow tape are two systems designed to guide Emergency Medical Services (EMS) providers in both pediatric patient weight estimation and medication dosing. The accuracy of the Handtevy method of weight estimation as practiced in the field by EMS has not been previously examined.Study Objective:The primary objective of this study was to examine the field performance of the Handtevy method and the Broselow tape with respect to prehospital patient weight estimation.Methods:This was a retrospective chart review of trauma and non-trauma patients transported by EMS to the emergency department (ED) of a quaternary care children’s hospital from January 1, 2021 through June 30, 2021. Demographic data, ED visit information, prehospital weight estimation, and medication dosing were collected and analyzed. Scale-based weight from the ED was used as the standard for comparison.Results:A total of 509 patients <13 years of age were included in this study. The EMS providers using the Broselow method estimated patient weight to within +/-10% of ED scale weight in 51.3% of patients. When using the Handtevy method, the EMS providers estimated patient weight to within +/-10% of ED scale weight in 43.7% of patients. When comparing the Handtevy versus Broselow method of prehospital weight estimation, there was no significant association between method and categorized weight discrepancy (over, under, or accurate estimates – defined as within 10% of ED scale weight; P = .25) or percent weight discrepancy (P = .75). On average, prehospital weight estimation was 6.33% lower than ED weight with use of the Handtevy method and 6.94% lower with use of the Broselow method.Conclusion:This study demonstrated no statistically significant difference between the use of the Handtevy or Broselow methods with respect to prehospital weight estimation. While further research is necessary, these results suggest similar field performance of the Broselow and Handtevy methods.

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supporting

confidence: 68%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Weighty Matters: A Real-World Comparison of the Handtevy and Broselow Methods of Prehospital Weight Estimation

Knudsen-Robbins

Pham

Zaky

et al. 2022

Prehosp. Disaster med.

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“…These medication aids are especially important in the case of pediatric patients, as weight-based dosing in kilograms is the standard of care and errors in dose calculations are common. According to a position paper released by the NAEMSP in 2020, all pediatric medication aids should list the volumetric amount of a weight-based dose to be given instead of a mass-based amount [25]. For example, a chart referencing pediatric acetaminophen dosing based on the standard concentration of 160mg/5 mL would list that a child weighing 11 kg would receive 5mL of acetaminophen rather than 160 mg. Any changes in formulary concentration should be immediately communicated and medication aids revised to reflect such changes as soon as possible.…”

Section: Pediatric Medication Safety Considerationsmentioning

confidence: 99%

Patient Safety in Emergency Medical Services

Wilson¹,

Woodrow²

2023

Contemporary Topics in Patient Safety - Volume 2

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Patients deserve high-quality, evidence-based care delivered from the moment they call for help to the moment they are safely delivered to the hospital. Often patient safety is not viewed as a fun or exciting topic by prehospital clinicians, but it need not be a burden. A culture of safety in emergency medical services can enhance patient outcomes and improve the overall safety in a community. The design and structure of the ambulance are the first layer of protection for patients. Couple that with ambulance operations topics, such as speed and light and siren use and that covers a large swath of the patient safety engineered into the system. There are patient-focused topics such as medication safety protocols, structured handoffs, and competency assessments of high-risk procedures that all serve to increase patient safety. Lastly, an emergency medical services clinician-oriented topic that also heavily impacts our patients is fatigue mitigation. Actively addressing fatigue and employing fatigue mitigation strategies can be used to enhance the safety of patients and will likely enhance the experience of prehospital clinicians in the organization.

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“…Adoption of simple pediatric interventions such as standardizing units for weight‐based dosing, 22 eliminating verbal orders, and limiting the number of different concentrations and dose strengths of stocked medications 21 will almost certainly decrease medication errors in our patients. Moreover, techniques with proven efficacy in vet patients should also be adopted.…”

Section: The Work Has Already Begunmentioning

confidence: 99%

The case for quality improvement in veterinary medicine

Daly¹

2022

J Vet Emergen Crit Care

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Medication Dosing Safety for Pediatric Patients: Recognizing Gaps, Safety Threats, and Best Practices in the Emergency Medical Services Setting. A Position Statement and Resource Document from NAEMSP

Cited by 20 publications

References 75 publications

Weighty Matters: A Real-World Comparison of the Handtevy and Broselow Methods of Prehospital Weight Estimation

Weighty Matters: A Real-World Comparison of the Handtevy and Broselow Methods of Prehospital Weight Estimation

Patient Safety in Emergency Medical Services

The case for quality improvement in veterinary medicine

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