Medication Errors in the Management of Anaphylaxis in a Pediatric Emergency Department

Benkelfat, Rislaine; Gouin, Serge; Larose, Gabriel; Bailey, Benoît

doi:10.1016/j.jemermed.2012.11.069

Cited by 23 publications

(12 citation statements)

References 18 publications

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“…One study that looked at junior physician knowledge of epinephrine dosing for anaphylaxis found that 28.4% of physicians would administer it intravenously and, of those who would administer it intramuscularly, 32.7% would administer 1 mg, and 30.9% did not know what dose to administer [31,32]. This is supported by studies that looked at the incidence of iatrogenic errors related to epinephrine use in anaphylactic cases, which was reported to be 2.4% in one study [33], and 15% (7/46) in another [34]. Although no iatrogenic adverse effects related to medication errors were noted in our study, such errors are potentially life-threatening, with reported complications including myocardial angina or infarcts, dysrhythmias, and intracerebral bleeds [30].…”

Section: Discussionmentioning

confidence: 99%

“…Although no iatrogenic adverse effects related to medication errors were noted in our study, such errors are potentially life-threatening, with reported complications including myocardial angina or infarcts, dysrhythmias, and intracerebral bleeds [30]. Given the low fatality rate of anaphylaxis in the ED and the low incidence of severe anaphylaxis, these iatrogenic risks need to be considered carefully in the application of anaphylaxis guidelines in the ED setting where the availability of multiple concentration of epinephrine for different indications, frequent interruptions, and the pressure of time-sensitive conditions all make it an error-prone environment [34,35].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Acute allergic reactions in the emergency department

Hitti¹,

Zaitoun

Harmouche³

et al. 2015

European Journal of Emergency Medicine

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Acute allergic reactions in the emergency department

Hitti¹,

Zaitoun

Harmouche³

et al. 2015

European Journal of Emergency Medicine

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“…Anafilaksi nedeniyle gerçekleşen ölümlerin en sık nedeninin adrenalin uygulamasındaki gecikmeden olması önemli bir sorundur (4). Bu eksikliklerin nedenlerine yönelik olarak yapılmakta olan çalışmaların sayısı her geçen gün artmaktadır (5)(6)(7)(8). Uluslararası literatürde anafilaksi tedavisi ve bu tedaviyi uygulayan sağlık çalışanlarının bilgi düzeyi ve uygulama pratiklerine yönelik olarak çok sayıda araştırma olmasına rağmen, ülkemizde bu konuda yapılmış çalışmalar kısıtlıdır (9)(10)(11)(12)(13)(14)(15).…”

Section: Discussionunclassified

Awareness of Physicians and Healthcare Providers Concerning Anaphylaxis and Epinephrine Auto-Injector Usage at a Tertiary Care Hospital

Özmen¹,

Aykan²,

Cörüt³

et al. 2015

jpr

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Özet ABS tRACtAim: Only epinephrine should be administered to treat anaphylaxis and patients should be prescribed epinephrine auto-injectors on discharge. This questionnaire study was designed to determine the awareness of physicians and other healthcare providers concerning anaphylaxis and the use of epinephrine auto-injectors at a tertiary child care hospital. Materials and Methods:The study was carried out between February 1 st and March 15 th , 2014 at Dr. Sami Ulus Maternity and Children's Research and Training Hospital, a tertiary care hospital. A total of 166 healthcare providers, including physicians and other staff such as nurses and paramedics, participated in the study. The demographic characteristics, experience in treating anaphylaxis and epinephrine auto-injector training were obtained using a standardized questionnaire. The obtained data were statistically analyzed. Results:The participants were composed of specialist doctors (25.9%), pediatric residents (31.9%) and other healthcare staff (42.2%). Eighty-four (50.6%) of the participants were found to have received training on anaphylaxis. Among the trained healthcare providers, 62 (73.8%) informed us that epinephrine by intramuscular route was applied during anaphylaxis. On the other hand, only 32 (39%) of untrained healthcare providers had chosen the intramuscular administration of epinephrine (p=0.00). 27.8% of those who had not received anaphylaxis training knew about it, while 64.8% of the healthcare providers who had received anaphylaxis training knew about adrenaline autoinjector. Only 5 of those who knew about the adrenaline auto-injector (5.3%) had prescribed the adrenaline report. While 81 (48.8%) of the participitants had some knowledge about the epinephrine auto-injector, only two specialists and three pediatric residents (3%) were found to prescribe the epinephrine auto-injector. Conclusion: Post-graduate training is required for the treatment of anaphylaxis. All healthcare providers should be trained on the use of epinephrine and prescribing epinephrine auto-injector.

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“…Many studies to reduce PEs and AEs in hospitalized children have investigated the impact of a single intervention such as education or training . The results of those studies showed that none of the interventions were superior in terms of error reduction.…”

Section: What Is Known and Objectivementioning

confidence: 99%

“…Many studies to reduce PEs and AEs in hospitalized children have investigated the impact of a single intervention such as education or training. [18][19][20][21][22][23][24][25][26][27][28][29][30] The results of those studies showed that none of the interventions were superior in terms of error reduction. The processes of prescribing and administration are complex because the causes of errors are multifactorial 8 and different conditions for behaviours are involved.…”

Section: What Is Known and Objectivementioning

confidence: 99%

Bundle interventions used to reduce prescribing and administration errors in hospitalized children: a systematic review

Bannan

Tully

2016

J Clin Pharm Ther

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Summary What is known and objective Bundle interventions are becoming increasingly used as patient safety interventions. The objective of this study was to describe and categorize which bundle interventions are used to reduce prescribing errors (PEs) and administration errors (AEs) in hospitalized children and to assess the quality of the published literature. Methods Articles published in English and Arabic between 1985 and September 2015 were sought in MEDLINE, EMBASE and CINHAL. Bibliographies of included articles were screened for additional studies. We included any study with a comparator group reporting rates of PEs and AEs. Two authors independently extracted data, classified interventions in each bundle and assessed the studies for potential risk of bias. Constituent interventions of the bundles were categorized using both the Cochrane Effective Practice and Organization of Care Group (EPOC) taxonomy of intervention and the Behavioural Change Wheel (BCW). Results and discussion Seventeen studies met the inclusion criteria. All bundles contained interventions that were either professional, organizational or a mixture of both. According to the BCW, studies used interventions with functions delivering environmental restructuring (17/17), education (16/17), persuasion (4/17), training (3/17), restriction (3/17), incentivization (1/17), coercion (1/17), modelling (1/17) and enablement (1/17). Nine studies had bundles with two intervention functions, and eight studies had three or more intervention functions. All studies were low quality before/after studies. Selection bias varied between studies. Performance bias was either low or unclear. Attrition bias was unclear, and detection bias was rated high in most studies. Ten studies described the interventions fairly well, and seven studies did not adequately explain the interventions used. What is new and conclusion This novel analysis in a systematic review showed that bundle interventions delivering two or more intervention functions have been investigated but that the study quality was too poor to assess impact.

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Medication Errors in the Management of Anaphylaxis in a Pediatric Emergency Department

Cited by 23 publications

References 18 publications

Acute allergic reactions in the emergency department

Acute allergic reactions in the emergency department

Awareness of Physicians and Healthcare Providers Concerning Anaphylaxis and Epinephrine Auto-Injector Usage at a Tertiary Care Hospital

Bundle interventions used to reduce prescribing and administration errors in hospitalized children: a systematic review

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