Medication Errors in Prehospital Management of Simulated Pediatric Anaphylaxis

Lammers, Richard L.; Willoughby-Byrwa, Maria; Fales, William

doi:10.3109/10903127.2013.856501

Cited by 51 publications

(54 citation statements)

References 40 publications

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“…17 Even when epinephrine was correctly chosen as the drug of choice in simulated pediatric anaphylaxis cases, only half of the providers were able to give the appropriate dose and route. 18 A recent retrospective analysis of prehospital rates of epinephrine administration in an urban tertiary care pediatric ED demonstrated that among children with anaphylaxis, only 36% were given epinephrine by EMS providers prior to their arrival in the emergency department, findings largely consistent with an earlier retrospective study of epinephrine administration in the pediatric population. 19,20 Two major reasons are cited for a delay in treatment including 1) correct identification of anaphylaxis and 2) hesitancy to administer epinephrine in pediatric patients who would benefit from early treatment.…”

Section: Introductionmentioning

confidence: 70%

Prehospital Administration of Epinephrine in Pediatric Anaphylaxis

Carrillo¹,

Hern²,

Barger³

2015

Prehospital Emergency Care

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Anaphylaxis in the pediatric population is both serious and potentially lethal. The incidence of allergic and anaphylactic reactions has been increasing and the need for life saving intervention with epinephrine must remain an important part of Emergency Medical Services (EMS) provider training. Our aim was to characterize dosing and timing of epinephrine, diphenhydramine, and albuterol in the pediatric patient with anaphylaxis. In this retrospective chart review, we studied prehospital medication administration in pediatric patients ages 1 month up to 14 years old classified as having a severe allergic reaction or anaphylaxis. We compared rates of epinephrine, diphenhydramine, and albuterol given to patients with allergic conditions including anaphylaxis. In addition, we calculated the rate of epinephrine administration in cases of anaphylaxis and determined what percentage of time the epinephrine was given by EMS or prior to their arrival. Of the pediatric patient contacts, 205 were treated for allergic complaints. Of those with allergic complaints, 98 of 205 (48%; 95% CI 41%, 55%) had symptoms consistent with anaphylaxis and indications for epinephrine. Of these 98, 53 (54%, 95% CI 44%, 64%) were given epinephrine by EMS or prior to EMS arrival. Among the patients in anaphylaxis not given epinephrine prior to EMS arrival, 6 (12%; 95% CI 3%, 21%) received epinephrine from EMS, 10 (20%; 95% CI 9%, 30%) received diphenhydramine only, 9 (18%, 95% CI 7%-28%) received only albuterol and 17 (33%, 95% CI 20%-46%) received both albuterol and diphenhydramine. 9 patients in anaphylaxis received no treatment prior to arriving to the emergency department (18%, 95% CI 7%-28%). In pediatric patients who met criteria for anaphylaxis and the use of epinephrine, only 54% received epinephrine and the overwhelming majority received it prior to EMS arrival. EMS personnel may not be treating anaphylaxis appropriately with epinephrine.

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Section: Introductionmentioning

confidence: 70%

Prehospital Administration of Epinephrine in Pediatric Anaphylaxis

Carrillo¹,

Hern²,

Barger³

2015

Prehospital Emergency Care

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“…In a large survey of paramedics, less than 50% identified epinephrine as the initial drug of choice . A simulation study of 62 EMS crews responding to a pediatric anaphylaxis event, Lammers et al . found that although 95% of crews administered epinephrine, only 46% delivered the correct concentration and route, with 20% giving a significant overdose and 15% administering via IV bolus.…”

Section: Discussionmentioning

confidence: 99%

Pitfalls in the use of epinephrine for anaphylaxis: patient and provider opportunities for improvement

Cohen

Saunders

Wise

et al. 2016

Int Forum Allergy Rhinol

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Epinephrine is a potent medication with lifesaving indications and is the standard of care for treatment of anaphylaxis. The delivery of epinephrine in both trained and untrained populations carries certain pitfalls and complications that can have serious consequences. Identification of the scope of the problem is an important step in improving education for both providers and patients who are tasked with use of epinephrine for allergy emergencies.

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“…In the studies by Lammers, there were many errors associated with stress including difficulty performing calculations and administering the wrong volume of medication. 14,23 Although we did see some suggestions of errors due to stress (participants walking out of the room in frustration and accidental needlesticks), we did not have a reliable way to measure this type of error and therefore, future study is needed to examine the effect of stress on errors.…”

Section: Discussionmentioning

confidence: 94%

“…Given that such expertise is hard to maintain, several studies have illustrated the high frequency of medication errors in pediatric patients in the prehospital setting. 12–14 …”

Section: Introductionmentioning

confidence: 99%

Comparison of Errors Using Two Length-Based Tape Systems for Prehospital Care in Children

Rappaport¹,

Brou²,

Givens³

et al. 2016

Prehospital Emergency Care

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Background: The use of a length/weight-based tape (LBT) for equipment size and drug dosing for pediatric patients is recommended in a joint statement by multiple national organizations. A new system, known as Handtevy™, allows for rapid determination of critical drug doses without performing calculations. Objective: To compare two LBT systems for dosing errors and time to medication administration in simulated prehospital scenarios. Methods: This was a prospective randomized trial comparing the Broselow Pediatric Emergency Tape™ (Broselow) and Handtevy LBT™ (Handtevy). Paramedics performed 2 pediatric simulations: cardiac arrest with epinephrine administration and hypoglycemia mandating dextrose. Each scenario was repeated utilizing both systems with a 1 year-old and 5 year-old size manikin. Facilitators recorded identified errors and time points of critical actions including time to medication. Results: We enrolled 80 paramedics, performing 320 simulations. For Dextrose, there were significantly more errors with Broselow (63.8 %) compared to Handtevy (13.8%) and time to administration was longer with the Broselow system (220 seconds vs. 173 seconds). For epinephrine, the LBTs were similar in overall error rate (Broselow 21.3% vs. Handtevy 16.3%) and time to administration (89 vs. 91 seconds). Cognitive errors were more frequent when using the Broselow compared to Handtevy, particularly with dextrose administration. The frequency of procedural errors was similar between the two LBT systems. Conclusion: In simulated prehospital scenarios, use of the Handtevy LBT system resulted in fewer errors for dextrose administration compared to the Broselow LBT, with similar time to administration and accuracy of epinephrine administration.

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Medication Errors in Prehospital Management of Simulated Pediatric Anaphylaxis

Abstract: Simulation, followed by a structured debriefing, identified multiple, underlying causes of medication errors in the prehospital management of pediatric anaphylactic reactions. Sequential and synergistic errors were observed with epinephrine delivery.

Cited by 51 publications

References 40 publications

Prehospital Administration of Epinephrine in Pediatric Anaphylaxis

Prehospital Administration of Epinephrine in Pediatric Anaphylaxis

Pitfalls in the use of epinephrine for anaphylaxis: patient and provider opportunities for improvement

Comparison of Errors Using Two Length-Based Tape Systems for Prehospital Care in Children

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