Paramedic Self-Reported Medication Errors

Vilke, Gary M.; Tornabene, Stephen V.; Stepanski, Barbara M.; Shipp, Holly E; Ray, Leslie Upledger; Metz, Marcelyn; Vroman, Dori; Anderson, Marilyn A.; Murrin, Patricia A.; Davis, Daniel P.; Harley, Jim R.

doi:10.1080/10903120601021358

Cited by 62 publications

(24 citation statements)

References 16 publications

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“…16 Data published on the incidence of clinical error is limited to retrospective chart reviews and self-reporting methodology, but reveals paramedics commit dosing errors 49–63% of the time with miscalculation as a primary cause. 4, 17–21 Simulation data also confirms medication dosing errors are common among currently practicing paramedics with calculation errors again identified as a major cause. 15, 22–24 Deficiencies in mathematics and application of mathematical principles have been investigated in students and currently practicing paramedics.…”

Section: Discussionmentioning

confidence: 77%

Color-coded prefilled medication syringes decrease time to delivery and dosing errors in simulated prehospital pediatric resuscitations: A randomized crossover trial

et al. 2015

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Background Medication dosing errors remain commonplace and may result in potentially life-threatening outcomes, particularly for pediatric patients where dosing often requires weight-based calculations. Novel medication delivery systems that may reduce dosing errors resonate with national healthcare priorities. Our goal was to evaluate novel, prefilled medication syringes labeled with color-coded volumes corresponding to the weight-based dosing of the Broselow Tape, compared to conventional medication administration, in simulated prehospital pediatric resuscitation scenarios. Methods We performed a prospective, block-randomized, cross-over study, where 10 full-time paramedics each managed two simulated pediatric arrests in situ using either prefilled, color-coded-syringes (intervention) or their own medication kits stocked with conventional ampoules (control). Each paramedic was paired with two emergency medical technicians to provide ventilations and compressions as directed. The ambulance patient compartment and the intravenous medication port were video recorded. Data were extracted from video review by blinded, independent reviewers. Results Median time to delivery of all doses for the intervention and control groups was 34 (95% CI: 28–39) seconds and 42 (95% CI: 36–51) seconds, respectively (difference = 9 [95% CI: 4–14] seconds). Using the conventional method, 62 doses were administered with 24 (39%) critical dosing errors; using the prefilled, color-coded syringe method, 59 doses were administered with 0 (0%) critical dosing errors (difference = 39%, 95% CI: 13–61%). Conclusions A novel color-coded, prefilled syringe decreased time to medication administration and significantly reduced critical dosing errors by paramedics during simulated prehospital pediatric resuscitations.

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Section: Discussionmentioning

confidence: 77%

Color-coded prefilled medication syringes decrease time to delivery and dosing errors in simulated prehospital pediatric resuscitations: A randomized crossover trial

et al. 2015

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“…41, 42 In prior research, EMTs under report medical errors and adverse events by an estimated 4%. 43–45 There is additional evidence that between 11% and 32% of occupational injuries and accidents are not voluntarily reported. 46, 47 Underreporting may be attributed to an unwillingness to report, particularly in agencies where a fear of retribution may result from a poor safety culture.…”

Section: Limitationsmentioning

confidence: 99%

Association Between Poor Sleep, Fatigue, and Safety Outcomes in Emergency Medical Services Providers

Patterson

Weaver

Frank

et al. 2012

Prehospital Emergency Care

189

206

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Objective To determine the association between poor sleep quality, fatigue, and self-reported safety outcomes among Emergency Medical Services (EMS) workers. Methods We used convenience sampling of EMS agencies and a cross-sectional survey design. We administered the 19-item Pittsburgh Sleep Quality Index (PSQI), 11-item Chalder Fatigue Questionnaire (CFQ), and 44-item EMS Safety Inventory (EMS-SI) to measure sleep quality, fatigue, and safety outcomes, respectively. We used a consensus process to develop the EMS-SI, which was designed to capture three composite measurements of EMS worker injury, medical errors and adverse events (AE), and safety compromising behaviors. We used hierarchical logistic regression to test the association between poor sleep quality, fatigue, and three composite measures of EMS worker safety outcomes. Results We received 547 surveys from 30 EMS agencies (a 35.6% mean agency response rate). The mean PSQI score exceeded the benchmark for poor sleep (6.9, 95%CI 6.6, 7.2). Greater than half of respondents were classified as fatigued (55%, 95%CI 50.7, 59.3). Eighteen percent of respondents reported an injury (17.8%, 95%CI 13.5, 22.1), forty-one percent a medical error or AE (41.1%, 95%CI 36.8, 45.4), and 89% (95%CI 87, 92) safety compromising behaviors. After controlling for confounding, we identified 1.9 greater odds of injury (95%CI 1.1, 3.3), 2.2 greater odds of medical error or AE (95%CI 1.4, 3.3), and 3.6 greater odds of safety compromising behavior (95%CI 1.5, 8.3) among fatigued respondents versus non-fatigued respondents. Conclusions In this sample of EMS workers, poor sleep quality and fatigue is common. We provide preliminary evidence of an association between sleep quality, fatigue, and safety outcomes.

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“…43,44 We acknowledge that prior research has documented EMTs under report medical errors and adverse events by an estimated 4%. 27,33,34 There is additional evidence that between 11% and 32% of occupational injuries and accidents are not reported. 7,45 Under reporting may be attributed to an unwillingness to report, particularly in agencies where a poor safety culture creates a fear of retribution.…”

Section: Limitationsmentioning

confidence: 99%

The Association between EMS Workplace Safety Culture and Safety Outcomes

Weaver

Wang

Fairbanks

et al. 2012

Prehospital Emergency Care

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Objective-Prior studies have highlighted wide variation in EMS workplace safety culture across agencies. We sought to determine the association between EMS workplace safety culture scores and patient or provider safety outcomes.Methods-We administered a cross-sectional survey to EMS workers affiliated with a convenience sample of agencies. We recruited these agencies from a national EMS management organization. We used the EMS Safety Attitudes Questionnaire (EMS-SAQ) to measure workplace safety culture and the EMS Safety Inventory (EMS-SI), a tool developed to capture self-reported safety outcomes from EMS workers. The EMS-SAQ provides reliable and valid measures of six domains: safety climate, teamwork climate, perceptions of management, perceptions of working conditions, stress recognition, and job satisfaction. A panel of medical directors, paramedics, and occupational epidemiologists developed the EMS-SI to measure selfreported injury, medical errors and adverse events, and safety-compromising behaviors. We used hierarchical linear models to evaluate the association between EMS-SAQ scores and EMS-SI safety outcome measures.Results-Sixteen percent of all respondents reported experiencing an injury in the past 3 months, four of every 10 respondents reported an error or adverse event (AE), and 90% reported safetycompromising behaviors. Respondents reporting injury scored lower on 5 of the 6 domains of safety culture. Respondents reporting an error or AE scored lower for 4 of the 6 domains, while respondents reporting safety-compromising behavior had lower safety culture scores for 5 of 6 domains.Conclusions-Individual EMS worker perceptions of workplace safety culture are associated with composite measures of patient and provider safety outcomes. This study is preliminary evidence of the association between safety culture and patient or provider safety outcomes.

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Paramedic Self-Reported Medication Errors

Abstract: Nine percent of paramedics responding to an anonymous survey report medication errors in the last 12 months, with 4% of these errors never having been reported in the CQI process. Additional safeguards must continue to be implemented to decrease the incidence of medication errors.

Cited by 62 publications

References 16 publications

Color-coded prefilled medication syringes decrease time to delivery and dosing errors in simulated prehospital pediatric resuscitations: A randomized crossover trial

Color-coded prefilled medication syringes decrease time to delivery and dosing errors in simulated prehospital pediatric resuscitations: A randomized crossover trial

Association Between Poor Sleep, Fatigue, and Safety Outcomes in Emergency Medical Services Providers

The Association between EMS Workplace Safety Culture and Safety Outcomes

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