Color-Coded Prefilled Medication Syringes Decrease Time to Delivery and Dosing Error in Simulated Emergency Department Pediatric Resuscitations

Abstract

Study objective The Institute of Medicine has called on the US health care system to identify and reduce medical errors. Unfortunately, medication dosing errors remain commonplace and may result in potentially life-threatening outcomes, particularly for pediatric patients when dosing requires weight-based calculations. Novel medication delivery systems that may reduce dosing errors resonate with national health care 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 with conventional medication administration, in simulated pediatric emergency department (ED) resuscitation scenarios. Methods We performed a prospective, block-randomized, crossover study in which 10 emergency physician and nurse teams managed 2 simulated pediatric arrest scenarios in situ, using either prefilled, color-coded syringes (intervention) or conventional drug administration methods (control). The ED resuscitation room and the intravenous medication port were video recorded during the simulations. Data were extracted from video review by blinded, independent reviewers. Results Median time to delivery of all doses for the conventional and color-coded delivery groups was 47 seconds (95% confidence interval [CI] 40 to 53 seconds) and 19 seconds (95% CI 18 to 20 seconds), respectively (difference=27 seconds; 95% CI 21 to 33 seconds). With the conventional method, 118 doses were administered, with 20 critical dosing errors (17%); with the color-coded method, 123 doses were administered, with 0 critical dosing errors (difference=17%; 95% CI 4% to 30%). Conclusion A novel color-coded, prefilled syringe decreased time to medication administration and significantly reduced critical dosing errors by emergency physician and nurse teams during simulated pediatric ED 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…”

Decreasing Prescribing Errors During Pediatric Emergencies: A Randomized Simulation Trial

“…27 A color-coded, prefilled syringe reduced critical dosing errors by emergency physician and nursing teams during simulated pediatric ED resuscitations. 28 However, a recent simulation study found a high rate of error by paramedics administering epinephrine according to 2 different length/weight-based tapes (Broselow, 21.3% vs Handtevy, 16.3%). 29 Pediatric epinephrine dosing in the prehospital setting is known to be error prone, even with standardization.…”

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.…”