A mobile device application to reduce medication errors and time to drug delivery during simulated paediatric cardiopulmonary resuscitation: a multicentre, randomised, controlled, crossover trial

Siebert, Johan N.; Ehrler, Frédéric; Combescure, Christophe; Lovis, Christian; Haddad, Kevin; Hugon, Florence; Luterbacher, Fanny; Lacroix, Laurence; Gervaix, Alain; Manzano, Sergio; Gehri, Mario; Yersin, Corinne; García, Daniel; Marina, Franziska Hermann; Pharisa, Cosette; Spannaus, Monika; Racine, Laurence; Laubscher, Bernard; Vah, Carole; Llor, Juan; Juzan, Aude

doi:10.1016/s2352-4642(19)30003-3

Cited by 48 publications

(51 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In the present study, medical dosing errors were reduced by 52 per cent with the TSPA when compared with the NPC. Similar findings associated with reductions in medical errors have been reported in certified human nurses when using a mobile device app to prepare cardiovascular support drugs as a CRI during cardiac arrest scenarios 14 21. Interestingly, both of these previous studies reported a similar incidence of incorrect answers (70 per cent and 75 per cent) using conventional methods when compared those reported in the present study (67 per cent) 14 21.…”

Section: Discussionsupporting

confidence: 88%

Clinical utility of a targeted smartphone application to aid veterinary students in calculating constant rate infusions and perioperative fluid drip rates

et al. 2020

View full text Add to dashboard Cite

BackgroundTo compare the utility of a targeted smartphone application (TSPA) with a non-programmable calculator (NPC) when calculating fluid drip rates (FDR) and constant rate infusions (CRIs).MethodsIn a prospective randomised clinical study, 48 fourth-year veterinary students entered one of four parallel groups involving two mock scenarios: fentanyl calculation using an NPC followed by lidocaine calculation using a TSPA, fentanyl (TSPA) followed by lidocaine (NPC), lidocaine (NPC) followed by fentanyl (TSPA) or lidocaine (TSPA) followed by fentanyl (NPC). Students calculated volume of drug added to maintenance fluids and drops/second that correctly administered the drug dose and FDR. Time to completion was assessed using an analysis of variance. A Fisher’s exact test assessed the effect of study period, scenario and device in the proportion of correct/incorrect answers.ResultsParticipants took longer to complete the scenarios in period 1 and 2 with the NPC (380.7±195.6 seconds and 488±154.8 seconds, respectively) than the TSPA (247.5±88.8 seconds and 224±94.2 seconds, respectively) (P<0.0031 and P<0.0001). Participants were more likely to complete the scenarios incorrectly with the NPC (n=32) when compared with the TSPA (n=7) (P<0.0001).ConclusionsTSPAs are more efficient and accurate when calculating CRIs and FDR compared with conventional methods. Medical mathematics must be emphasised during the veterinary curriculum.

show abstract

Section: Discussionsupporting

confidence: 88%

Clinical utility of a targeted smartphone application to aid veterinary students in calculating constant rate infusions and perioperative fluid drip rates

et al. 2020

View full text Add to dashboard Cite

show abstract

“…An app to help nurses prepare and administer drugs for infusion during in-hospital pediatric resuscitation has been recently developed and tested in a simulation-based RCT. The app was effective in reducing errors and time to preparation/delivery of medications compared with conventional methods [ 57 ]. Another simulation-based RCT, from the same research group, has shown a reduction in the time to critical actions and in the deviations from guidelines recommendations in the management of a shockable PCA in the group guided by an app for tablet compared with the group that used the PALS pocket reference card [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Development and Usability of a Novel Interactive Tablet App (PediAppRREST) to Support the Management of Pediatric Cardiac Arrest: Pilot High-Fidelity Simulation-Based Study

Corazza¹,

Snijders²,

Arpone³

et al. 2020

JMIR Mhealth Uhealth

View full text Add to dashboard Cite

Background Pediatric cardiac arrest (PCA), although rare, is associated with high mortality. Deviations from international management guidelines are frequent and associated with poorer outcomes. Different strategies/devices have been developed to improve the management of cardiac arrest, including cognitive aids. However, there is very limited experience on the usefulness of interactive cognitive aids in the format of an app in PCA. No app has so far been tested for its usability and effectiveness in guiding the management of PCA. Objective To develop a new audiovisual interactive app for tablets, named PediAppRREST, to support the management of PCA and to test its usability in a high-fidelity simulation-based setting. Methods A research team at the University of Padova (Italy) and human–machine interface designers, as well as app developers, from an Italian company (RE:Lab S.r.l.) developed the app between March and October 2019, by applying an iterative design approach (ie, design–prototyping–evaluation iterative loops). In October–November 2019, a single-center nonrandomized controlled simulation–based pilot study was conducted including 48 pediatric residents divided into teams of 3. The same nonshockable PCA scenario was managed by 11 teams with and 5 without the app. The app user’s experience and interaction patterns were documented through video recording of scenarios, debriefing sessions, and questionnaires. App usability was evaluated with the User Experience Questionnaire (UEQ) (scores range from –3 to +3 for each scale) and open-ended questions, whereas participants’ workload was measured using the NASA Raw-Task Load Index (NASA RTLX). Results Users’ difficulties in interacting with the app during the simulations were identified using a structured framework. The app usability, in terms of mean UEQ scores, was as follows: attractiveness 1.71 (SD 1.43), perspicuity 1.75 (SD 0.88), efficiency 1.93 (SD 0.93), dependability 1.57 (SD 1.10), stimulation 1.60 (SD 1.33), and novelty 2.21 (SD 0.74). Team leaders’ perceived workload was comparable (P=.57) between the 2 groups; median NASA RTLX score was 67.5 (interquartile range [IQR] 65.0-81.7) for the control group and 66.7 (IQR 54.2-76.7) for the intervention group. A preliminary evaluation of the effectiveness of the app in reducing deviations from guidelines showed that median time to epinephrine administration was significantly longer in the group that used the app compared with the control group (254 seconds versus 165 seconds; P=.015). Conclusions The PediAppRREST app received a good usability evaluation and did not appear to increase team leaders’ workload. Based on the feedback collected from the participants and the preliminary results of the evaluation of its effects on the management of the simulated scenario, the app has been further refined. The effectiveness of the new version of the app in reducing deviations from guidelines recommendations in the management of PCA and its impact on time to critical actions will be evaluated in an upcoming multicenter simulation-based randomized controlled trial.

show abstract

“…The physician will order sequentially the medications using International Non-proprietary Names and allow progression through the scenario only once predefined milestones have been reached, irrespective of error occurrence or the time taken to achieve them. Study-specific training and standardization of the second paramedic and physician is ensured through their involvement in the previous in-hospital studies [23, 32] and by following the predefined scenario.…”

Section: Methodsmentioning

confidence: 99%

“…All actions performed with the app will be automatically saved locally in log files for further analysis. The validity and reliability of the app has been assessed in prior studies [23, 32]. The stress level (HR) of each participant will be recorded during the entire resuscitation scenario with the HR monitor on a Polar A360 watch (Polar Electro Oy, Kempele, Finland).…”

Section: Methodsmentioning

confidence: 99%

“…In a previous multicenter, randomized crossover trial, we showed that medication errors, time to drug preparation, and time to drug delivery for continuous infusions during simulation-based, pediatric, in-hospital post-cardiac-arrest scenarios were significantly reduced by using a mobile device app (the pediatric accurate medication in emergency situations (pediatric Accurate Medication IN Emergency Situations (PedAMINES)) designed to help pediatric drug preparation [23].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A mobile device app to reduce prehospital medication errors and time to drug preparation and delivery by emergency medical services during simulated pediatric cardiopulmonary resuscitation: study protocol of a multicenter, prospective, randomized controlled trial

Siebert

Bloudeau²,

Ehrler

et al. 2019

Trials

Self Cite

View full text Add to dashboard Cite

BackgroundEmergency drug preparation and administration in children is both complex and time-consuming and places this population at a higher risk than adults for medication errors. Moreover, survival and a favorable neurological outcome from cardiopulmonary resuscitation are inversely correlated to drug preparation time. We developed a mobile device application (the pediatric Accurate Medication IN Emergency Situations (PedAMINES) app) as a step-by-step guide for the preparation to delivery of drugs requiring intravenous injection. In a previous multicenter randomized trial, we reported the ability of this app to significantly reduce in-hospital continuous infusion medication error rates and drug preparation time compared to conventional preparation methods during simulation-based pediatric resuscitations. This trial aims to evaluate the effectiveness of this app during pediatric out-of-hospital cardiopulmonary resuscitation.Methods/designWe will conduct a multicenter, prospective, randomized controlled trial to compare the PedAMINES app with conventional calculation methods for the preparation of direct intravenously administered emergency medications during standardized, simulation-based, pediatric out-of-hospital cardiac arrest scenarios using a high-fidelity manikin. One hundred and twenty paramedics will be randomized (1:1) in several emergency medical services located in different regions of Switzerland. Each paramedic will be asked to prepare, sequentially, four intravenously administered emergency medications using either the app or conventional methods. The primary endpoint is the medication error rates. Enrollment will start in mid-2019 and data analysis in late 2019. We anticipate that the intervention will be completed in early 2020 and study results will be submitted in late 2020 for publication (expected in early 2021).DiscussionThis clinical trial will assess the impact of an evidence-based mobile device app to reduce the rate of medication errors, time to drug preparation and time to drug delivery during prehospital pediatric resuscitation. As research in this area is scarce, the results generated from this study will be of great importance and may be sufficient to change and improve prehospital pediatric emergency care practice.Trial registrationClinicalTrials.gov, ID: NCT03921346. Registered on 18 April 2019.

show abstract

A mobile device application to reduce medication errors and time to drug delivery during simulated paediatric cardiopulmonary resuscitation: a multicentre, randomised, controlled, crossover trial

Cited by 48 publications

References 24 publications

Clinical utility of a targeted smartphone application to aid veterinary students in calculating constant rate infusions and perioperative fluid drip rates

Clinical utility of a targeted smartphone application to aid veterinary students in calculating constant rate infusions and perioperative fluid drip rates

Development and Usability of a Novel Interactive Tablet App (PediAppRREST) to Support the Management of Pediatric Cardiac Arrest: Pilot High-Fidelity Simulation-Based Study

A mobile device app to reduce prehospital medication errors and time to drug preparation and delivery by emergency medical services during simulated pediatric cardiopulmonary resuscitation: study protocol of a multicenter, prospective, randomized controlled trial

Contact Info

Product

Resources

About