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

Abstract

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.

Intubation drug pack containing pre-filled syringes reduces the time to endotracheal intubation in a simulated paediatric emergency

“…Our study supports other work in this area such as a study in the adult theatre environment that demonstrated a reduction in time in medication preparation and reduced wastage at a neutral cost for the hospital 9. It also supports studies with colour-coded syringes for paediatric emergencies in the pre-hospital environment and emergency department, which showed decreased time for medication administration and reduced critical dosing errors 10 11…”

Pediatric Readiness in the Emergency Department

“…18 This statement and other recent work have revealed the value of specific structural and process measures on improved patient safety and quality of care. For example, a weight-based, color-coded medication safety system can be used to decrease dosing errors and improve the timeliness of dosing, 19,20 and order sets, reminders, and clinical practice recommendations embedded within information systems can be used to increase adherence to best practices. 21,22 Although previous guidelines 1,2 were consensus based, several recent studies have revealed the effects of pediatric readiness on outcomes for children treated in EDs.…”

Accuracy of weight estimation by the Broselow tape is substantially improved by including a visual assessment of body habitus

“…The primary outcome measure was the performance of each of the modified Broselow models with respect to drug-dose correctness, when compared with a dose based on measured weight. For this study, a drug-dose deviation of 410% of the calculated true dose was considered to be an incorrect dose and a dose deviation of 420% of the actual dose was considered to be a critical dose error (27,28). An improvement on the current BT accuracy of 410% was regarded as significant.…”