Abstract 150: Color-Coded, Prefilled Syringes Corresponding to the Broselow Tape Decrease Medication Time to Administration and Errors Among Emergency Physicians and Nurses in Simulated Critically Ill Pediatric Patients
Background: Pediatric resuscitations are inherently stressful and clinicians use various methods of determining drug dosing. The processes of calculation may lead to delay or error in drug administration. The purpose of this study was to assess the effect of color-coded, prefilled medication syringes corresponding to the Broselow Tape on time to medication administration and dosing errors.
Methods: Design: Blinded randomized cross-over trial. Population: 10 teams comprised of 1 physician and 1 nurse, each participating in 2 high-fidelity simulations, an 8-month old asystolic arrest (SIDS) and an 8-year old asystolic arrest (sepsis). Intervention: Color-coded, prefilled syringes corresponding to the Broselow Tape. Control: Manually-calculated dosing using the Broselow Tape. The teams were randomized to 1 group and subsequently crossed-over after a 1 month washout period. Data Collection: Time to administration of drugs and drug dosing during each scenario using videotaped confirmation by blinded independent medical students. Outcomes: Timing of medication dose and proportions of errors (defined as any deviation from the recommended dose per kilogram) and critical errors (defined as >25% deviation).
Results: Participants averaged 12 years of clinical experience. The median time to delivery of all medications in the intervention and control groups was 19 (interquartile range [IQR]: 16-23) and 47 (IQR: 29-61) seconds, respectively (difference = 26 seconds, 95% confidence interval [CI]: 20-32 seconds, p<0.001). In the intervention and control groups, 125 and 119 medication doses were administered, respectively; of these, there were 6 (5%) and 23 (19%) total dosing errors, respectively (difference = 14%, 95% CI: 7%-23%, p<0.001), and 0 (0%) and 20 (17%) critical dosing errors, respectively (difference = 17%, 95% CI: 10%-24%, p<0.001).
Conclusions: Color-coded prefilled syringes corresponding to the Broselow Tape significantly decreased time to administration of medication and eliminated critical dosing errors in simulated pediatric cardiac arrest scenarios. This novel dosing approach may impact standard resuscitation practices in this unique patient population.
- © 2012 by American Heart Association, Inc.