Paramedic-Identified Enablers of and Barriers to Pediatric Seizure Management: A Multicenter, Qualitative Study

Carey, J; Studnek, Jonathan R.; Browne, Lorin R.; Ostermayer, Daniel; Grawey, Thomas; Schroter, Stephanie; Lerner, E. Brooke; Shah, Manish I.

doi:10.1080/10903127.2019.1595234

Cited by 21 publications

(19 citation statements)

References 33 publications

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“…Numerous barriers exist to optimum adherence to available prehospital protocols. Carey et al 11 described enablers and barriers to EMS provider protocol adherence and changes in EMS practices. They document paramedic-identified enablers and barriers to prehospital pediatric seizure management, differentiating between systems-level and provider-level.…”

Section: Discussionmentioning

confidence: 99%

“…They document paramedic-identified enablers and barriers to prehospital pediatric seizure management, differentiating between systems-level and provider-level. 11 Systems-level enablers of protocol adherence included point-of-care decision support tools, the availability of multiple dosing routes for medication administration, and medical direction availability. 11 Systems-level barriers to protocol adherence included protocol ambiguity, paramedic uncertainty regarding aspects of the protocol, equipment barriers, and lack of specific training.…”

Section: Discussionmentioning

confidence: 99%

“… 11 Systems-level enablers of protocol adherence included point-of-care decision support tools, the availability of multiple dosing routes for medication administration, and medical direction availability. 11 Systems-level barriers to protocol adherence included protocol ambiguity, paramedic uncertainty regarding aspects of the protocol, equipment barriers, and lack of specific training. Provider-level barriers to protocol adherence included paramedic concerns around side effects from medication administration, dosing errors due to provider fatigue, inaccurate methods of weight estimation, and provider perceptions about medication effectiveness.…”

Section: Discussionmentioning

confidence: 99%

“…Delayed uptake and adherence to pediatric prehospital protocols have been shown in our community and the literature. 11 Prior studies have shown the use of multifaceted educational interventions to improve adherence to evidence-based pediatric prehospital protocols. 12 The objective of this study was to use quality improvement science to increase adherence to the recommendation for prehospital oral corticosteroid administration for children with asthma exacerbations.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Improving Administration of Prehospital Corticosteroids for Pediatric Asthma

Riney

Schwartz

Kurowski

et al. 2021

Pediatric Quality &Amp; Safety

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Introduction: Early administration of systemic corticosteroids for asthma exacerbations in children is associated with improved outcomes. Implementation of a new emergency medical services (EMS) protocol guiding the administration of systemic corticosteroids for pediatric patients with asthma exacerbations went into effect in January 2016 in Southwest Ohio. Our SMART aim was to increase the proportion of children receiving systemic prehospital corticosteroids for asthma exacerbations from 0% to 70% over 2 years. Methods: Key drivers were derived and tested using multiple plan-do-study-act cycles. Interventions included community EMS outreach and education, improved clarity in the prehospital protocol language, distribution of pocket-sized educational cards, and ongoing individualized EMS agency feedback on protocol adherence. Eligible patients included children age 3–16 years, who were transported by EMS to the pediatric emergency department with diagnoses consistent with asthma exacerbation. Manual chart review assessed eligibility to receive prehospital corticosteroids. Statistical process control charts tracked adherence to corticosteroid recommendations. Results: A total of 256 encounters met the criteria for receiving prehospital corticosteroids for pediatric asthma exacerbations between January 1, 2016, and April 30, 2019. Special cause variation was demonstrated following education at high-volume EMS stations, and the centerline shifted to 34%. This shift has been sustained for 28 months. Conclusion: Improvement methodology increased prehospital corticosteroid administration for pediatric asthma exacerbations, although we failed to achieve our aim of increasing use to 70%. Many barriers exist in pediatric prehospital protocol implementation, many of which can be improved with quality improvement tools.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Improving Administration of Prehospital Corticosteroids for Pediatric Asthma

Riney

Schwartz

Kurowski

et al. 2021

Pediatric Quality &Amp; Safety

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“…Paediatric resuscitation in pre‐hospital and ED settings is an unpredictable, high‐risk, high‐stress and high‐stakes environment, making it prone to human error . Of children who seek emergency care in the USA, 70% attend EDs that see fewer than 15 paediatric patients per day, and junior medical staff may have had limited paediatric resuscitation training and are unlikely to have experienced a paediatric critical event . A recent study by Bhanji et al .…”

mentioning

confidence: 99%

A systems‐centred approach to reducing medication error: Should pre‐hospital providers and emergency departments dose children by age during resuscitation?

Foster

Tagg

2019

J Paediatrics Child Health

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The high-risk, high-stress and high-stakes environment of out-of-hospital or emergency department paediatric resuscitation is prone to human error, and medication errors are common. This could be contributing to the difference in survival rate of resuscitation in the out-ofhospital versus inpatient setting. Medication for children during resuscitation requires estimation of the child's weight and calculation of the corresponding drug dose. Whilst both of these steps can lead to error, calculation errors (including 10-fold errors) are much more common and harmful than weight errors. Previous solutions aim to optimise each stage of the medication dosing process. Currently, Australian guidelines suggest using the highly inaccurate original advanced paediatric life support formula, weight = 2 × (age + 4), to dose medications in these settings. This means age is converted to weight, which is then converted to dose. There is no evidence that this is causing harm to patients. Therefore, it could be suggested that age could safely be converted straight to dose according to preset doses. This eliminates the need for any weight estimation or dose calculation, thus reducing the potential for error and harm.

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