Dosing Errors Made by Paramedics During Pediatric Patient Simulations After Implementation of a State-Wide Pediatric Drug Dosing Reference
Dosing Errors Made by Paramedics During Pediatric Patient Simulations After Implementation of a State-Wide Pediatric Drug Dosing Reference
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DOI：
10.1080/10903127.2019.1619002
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发表时间：
2020-03-03
影响因子：
2.4
通讯作者：
Lammers, Richard L.
中科院分区：
文献类型：
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作者：
Hoyle, John D.;Ekblad, Glenn;Lammers, Richard L.
背景：入院前儿科患者的给药错误发生率很高。为了减少错误，密歇根州实施了全州范围的儿科剂量参考（PDR），剂量以毫升为单位列出，要求使用旋塞阀从预装注射器中将剂量吸入较小的注射器中，并将某些药物稀释至不同浓度。目的：评估在全州范围内实施PDR后的用药错误率，包括遗漏和错误。研究方法：来自15个机构的EMS工作人员完成了4个经过验证的模拟场景：婴儿癫痫发作，婴儿心脏骤停，18个月大的烧伤和5岁的过敏性休克。机构有私人的，公共的，非营利性的，营利性的，城市的，农村的，消防的，和第三服务。EMS工作人员使用他们的常规设备，并被要求执行所有步骤，以管理药物剂量。两名评估员通过直接观察和视频审查对机组人员的表现进行评分。误差定义为与体重适当剂量相比差异20%。使用描述性统计。结果：共完成142次模拟。大多数船员（58.3%）是紧急医疗技术人员-辅助医务人员（EMTP）/EMTP。对于心脏骤停情况，51/70（72.9%; 95% CI：60.9%，82.8%）肾上腺素剂量是正确的。有6例（8.6%，95% CI：2.0%，15.1%）10倍过量，1例（1.4%; 95% CI：-1.4%，4.2%）10倍剂量不足。在癫痫发作情况下，28/50例（56.0%; 95% CI：42.2%，69.8%）苯二氮卓类药物剂量正确; 6/18例（33.3%; 95% CI：11.5%，55.1%）药物稀释不正确，导致给药错误。给药注射器中经常夹带无法识别的空气，导致剂量不足。总体而言，31.2%（95% CI：25.5%，36.6%）的药物剂量不正确。在18/142例（12.7%，95% CI：7.2%，18.2%）病例中，获得不正确的体重导致药物给药错误。遗漏的错误包括在癫痫发作情况下未能检查血糖，以及在过敏性休克中未能给予肾上腺素和液体推注。结论：尽管实施了PDR，给药错误（包括10倍错误）的发生率仍然很高。使用稀释和基于长度的磁带时会出现错误。除了PDR之外，儿科院前给药还需要进一步减少错误的策略，以针对遗漏错误。
Background: Drug dosing errors occur at a high rate for prehospital pediatric patients. To reduce errors, Michigan implemented a state-wide pediatric dosing reference (PDR), with doses listed in milliliters, the requirement that doses be drawn into a smaller syringe from a pre-loaded syringe using a stopcock, and dilution of certain drugs to different concentrations. Purpose: To evaluate the rate of medication errors, including errors of omission and commission, after implementation of a state-wide PDR. Methods: EMS crews from 15 agencies completed 4 validated, simulation scenarios: an infant seizing, an infant cardiac arrest, an 18-month-old with a burn, and 5-year-old with anaphylactic shock. Agencies were private, public, not-for-profit, for-profit, urban, rural, fire-based, and third service. EMS crews used their regular equipment and were required to carry out all the steps to administer a drug dose. Two evaluators scored crew performance via direct observation and video review. An error was defined as 20% difference compared to the weight-appropriate dose. Descriptive statistics were utilized. Results: A total of 142 simulations were completed. The majority of crews were (58.3%) Emergency Medical Technician-Paramedic (EMTP)/EMTP. For the cardiac arrest scenario, 51/70 (72.9%; 95% CI: 60.9%, 82.8%) epinephrine doses were correct. There were 6 (8.6%, 95% CI: 2.0%, 15.1%) 10-fold overdoses and one (1.4%; 95% CI: -1.4%, 4.2%), 10-fold under dose. In the seizure scenario, 28/50 (56.0%; 95% CI: 42.2%, 69.8%) benzodiazepine doses were correct; 6/18 (33.3%; 95% CI: 11.5%, 55.1%) drug dilutions were incorrect resulting in dosing errors. Unrecognized air was frequently entrained into the administration syringe resulting in under doses. Overall, 31.2% (95% CI: 25.5%, 36.6%) of drug doses were incorrect. Obtaining an incorrect weight led to a drug dosing error in 18/142 (12.7%, 95% CI: 7.2%, 18.2%) cases. Errors of omission included failure to check blood sugar in the seizure scenario and failure to administer epinephrine and a fluid bolus in anaphylactic shock. Conclusion: Despite implementation of a PDR, dosing errors, including 10-fold errors, still occur at a high rate. Errors occur with dilution and length-based tape use. Further error reduction strategies, beyond a PDR and that target errors of omission, are needed for pediatric prehospital drug administration.