Analysis of Medication Errors in Simulated Pediatric Resuscitation by Residents

Abstract

IntroductionThe objective of our study was to estimate the incidence of prescribing medication errors specifically made by a trainee and identify factors associated with these errors during the simulated resuscitation of a critically ill child.MethodsThe results of the simulated resuscitation are described. We analyzed data from the simulated resuscitation for the occurrence of a prescribing medication error. We compared univariate analysis of each variable to medication error rate and performed a separate multiple logistic regression analysis on the significant univariate variables to assess the association between the selected variables.ResultsWe reviewed 49 simulated resuscitations. The final medication error rate for the simulation was 26.5% (95% CI 13.7% – 39.3%). On univariate analysis, statistically significant findings for decreased prescribing medication error rates included senior residents in charge, presence of a pharmacist, sleeping greater than 8 hours prior to the simulation, and a visual analog scale score showing more confidence in caring for critically ill children. Multiple logistic regression analysis using the above significant variables showed only the presence of a pharmacist to remain significantly associated with decreased medication error, odds ratio of 0.09 (95% CI 0.01 – 0.64).ConclusionOur results indicate that the presence of a clinical pharmacist during the resuscitation of a critically ill child reduces the medication errors made by resident physician trainees.

Medication Errors in Cardiopulmonary Arrest and Code-Related Situations

“…Of the 58 syringes analyzed by the laboratory, 16% had a deviation greater than 20% from the expected dose, and 7% deviated from the expected dose by 50% or more. A similar study by Porter et al 8 involving simulated resuscitation of a child by medical residents was published in 2014. Before intervention by other health care professionals, the potential error rate was 40.8%.…”

“…Other articles were excluded for the following reasons: 852 were not deemed code related as defined for this review, 4 were review articles, 10 were editorials or letters to the editor, 11 were intervention studies, 9 involved the prehospital setting, 2 were evaluations of errors other than medication errors, and 1 did not quantify the medication errors mentioned. The included studies [4][5][6][7][8][9] are summarized in Table 1. Both authors (A.H.F.…”

“…Dosing errors have ranged from 2% to 65% of the total code-related medication errors, although errors involving dosing may have been classified in other categories, such as prescribing. 8,9 The ISMP 18 provides recommendations on accessibility of drug information during resuscitation events. In addition to ensuring that reference cards with typical doses and titration guidance are available, other system factors deserve attention.…”

In Reply

“…4–8 Our reported rates are consistent, and in many cases on the low end or lower than those reported using direct observation and similar ME definitions in the perioperative setting (ME rates 9–11%), 9 and those using our validated and widely used definition of ME with either chart review or direct observational methods in other settings such as the medical emergency/code setting (ME rates 4.4–50%), 10,11 critical care setting (ME rates 9–20%), 12,13 inpatient setting (ME rates 5–19%), 14–17 outpatient setting (ME rates 7–12%) 18–20 and simulation setting (ME rates 0.5–26.5%). 16,21 …”

High-tech adjuncts to emergency weight estimation: Point-of-care ultrasound and point-of-care bioelectrical impedance measurements can increase the accuracy of length-based weight estimation in children

“…It follows that if the weight estimate is not accurate then the resulting drug dose will not be accurate, which may result in patient harm [2][3][4]. The use of weight-estimation techniques known to be inaccurate should therefore not be toleratedthe most accurate systems that are practical during emergencies should be utilised [5,6].…”