Pediatric Prehospital Medication Dosing Errors: A National Survey of Paramedics

Hoyle, John D.; Crowe, Remle P.; Bentley, Melissa; Beltran, Gerald; Fales, William

doi:10.1080/10903127.2016.1227001

Cited by 46 publications

(52 citation statements)

References 21 publications

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“…First, the response rate to the questionnaire was relatively low; 29%. Previous questionnaire studies showed similar response rates among EMS providers [50][51][52]. As shown by the range in years of experience among the responders, the results are expected to be representative for all EMS providers of both regions.…”

Section: Discussionmentioning

confidence: 53%

The role of emergency medical service providers in the decision-making process of prehospital trauma triage

Rein

Sadiqi

Lansink

et al. 2018

Eur J Trauma Emerg Surg

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Purpose Severely injured patients should be treated at higher-level trauma centres, to improve chances of survival and avert life-long disabilities. Emergency medical service (EMS) providers must try to determine injury severity on-scene, using a prehospital trauma triage protocol, and decide the most appropriate type of trauma centre. The objective of this study is to investigate the role of EMS provider judgment in the prehospital triage process of trauma patients, by analysing the compliance rate to the protocol and administering a questionnaire among EMS providers. Methods All trauma patients transported to a trauma centre in two different regions of the Netherlands were analysed. Compliance rate was based on the number of patients meeting the triage criteria and transported to the corresponding level trauma centre. The questionnaire was administered among EMS providers. Descriptive statistics were used to analyse the data. Results For adult patients, the compliance rate to the level I criteria of the triage protocol was 72% in Central Netherlands and 42% in Brabant. For paediatric patients, this was 63% and 38% in Central Netherlands and Brabant, respectively. The judgment on injury severity was mostly based on the injury-type criteria. Additionally, the distance to a level I trauma centre influenced the decision for destination facility in the Brabant region. Conclusion The compliance rate varied between regions. Improvement of prehospital trauma triage depends on the accuracy of the protocol and compliance rate. A new protocol, including EMS provider judgment, might be the key to improvement in the prehospital trauma triage quality.

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Section: Discussionmentioning

confidence: 53%

The role of emergency medical service providers in the decision-making process of prehospital trauma triage

Rein

Sadiqi

Lansink

et al. 2018

Eur J Trauma Emerg Surg

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“…Many critical situations also require the use of drugs or substrates that require a pharmacological intervention to restore vital functions and prevent patients from deteriorating (e.g., anticonvulsive drugs, dextrose, etc.). Although much attention has been paid to in-hospital pediatric emergent medication errors which are present in almost half of all resuscitation cases [12], with significant dose deviation from the prescribed dose reported in up to 16% of the analyzed syringes [35], data regarding EMS-related prehospital medication errors and error prevention strategies are scarce [13]. However, EMS are largely exposed to opportunities for out-of-hospital medication errors, thus severely compromising patient safety.…”

Section: Discussionmentioning

confidence: 99%

“…The latter has been shown to be higher and error-prone when a task is uncommon [45, 47, 48]. Paramedics have little exposure to critically ill children and lack experience to administer emergency medications at pediatric doses [49], with minimal opportunities to gain and maintain competence in this skill [13, 15]. Pediatric situations only account for about 7% of EMS calls [16, 50].…”

Section: Discussionmentioning

confidence: 99%

“…Despite well-equipped and staffed environments with numerous available safeguards, direct IV medication errors have been reported in up to 41% of cases during simulated in-hospital pediatric resuscitations, 65% of which were incorrect medication dosage, thus making it the most common error [12]. The rate of errors is also important in the high-risk prehospital setting, which is reported as occurring in more than 30% of all pediatric drugs administered, with an error rate for epinephrine dosage alone of more than 60% [13]. In this particular context, initial care has to be delivered quickly by emergency medical services (EMS) in challenging field environments where resources and providers are limited [14].…”

Section: Introductionmentioning

confidence: 99%

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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

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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.

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“…Although there were a large number of responses, the overall response rate was low, consistent with most electronic surveys in this population. 21 However, based on the sample size calculation, more than enough responses were received to make estimates with 95% confidence. Further, the geographic distribution of respondents was similar to the distribution of NRPs across the United States.…”

Section: Limitationsmentioning

confidence: 99%

Ketamine in the Prehospital Environment: A National Survey of Paramedics in the United States

Buckland

Crowe

Cash

et al. 2017

Prehosp. Disaster med.

Self Cite

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This was the first large, national survey to assess ketamine training, use, and perceptions among paramedics in the civilian prehospital setting. While training related to ketamine use was commonly reported among paramedics, few were authorized to administer the drug by their agency's protocols. Of those authorized to use ketamine, most paramedics had limited experience administering the drug. Future research is needed to determine why the prevalence of ketamine use is low and to assess the safety and efficacy of ketamine use in the prehospital setting. Buckland DM , Crowe RP , Cash RE , Gondek S , Maluso P , Sirajuddin S , Smith ER , Dangerfield P , Shapiro G , Wanka C , Panchal AR , Sarani B . Ketamine in the prehospital environment: a national survey of paramedics in the United States. Prehosp Disaster Med. 2018;33(1):23-28.

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Pediatric Prehospital Medication Dosing Errors: A National Survey of Paramedics

Cited by 46 publications

References 21 publications

The role of emergency medical service providers in the decision-making process of prehospital trauma triage

The role of emergency medical service providers in the decision-making process of prehospital trauma triage

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

Ketamine in the Prehospital Environment: A National Survey of Paramedics in the United States

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