Augmenting the On-scene Medic (ATOM): Development of a head-mounted display application to reduce prehospital pediatric medication errors

项目摘要 本项目的目标是开发一个安全有效的动态认知辅助应用程序， 通过头戴式显示器（HMD），以降低与儿科用药相关的错误率 紧急医疗服务（EMS）的PMA管理。为达致这个目标，我们会研究 与PMA相关的特性，使用设计思维过程开发原型应用程序， 检查原型的可用性，并在随机对照试验中测试安全性和有效性。 EMS中与PMA相关的错误高得惊人。许多研究表明，有31%的 EMS给儿童使用的所有药物的错误率。咪达唑仑和芬太尼等药物 甚至更高的比率，分别为61%和65%，其中许多是10倍的错误。可悲的是，以前的策略 对将错误率降低到31%以下几乎没有影响。由于不一致，系统更改失败 在EMS系统中，以及与药物短缺相关的挑战。以前开发的认知辅助工具 由于它们通常作为简单的参考工具，不能解决所有问题， 与PMA相关的错误原因。因此，我们提出了最全面的设计流程， 为了解决这个问题，利用先进的技术，实施动态认知援助， 供应商在PMA期间提高剂量准确性。 我们假设EMS中的PMA错误将通过此应用程序显着减少， 我们将利用全面而严格的设计思维过程，然后进行随机对照试验， 测试安全性和有效性。我们的跨学科团队将联合收割机结合儿科急诊医学领域， EMS，工程，计算机科学和用户界面/用户体验，以解决这个问题的支持 和密歇根州两所医学院的努力。在SA 1中，我们将开发一个原型应用程序。这将开始 识别与PMA相关的用户和上下文信息，并检查故障模式，根本原因， 以及对该过程的任务分析。然后，我们将进行全面的设计思维过程， 开发应用程序。在此过程中，我们还将创建一个桌面程序，允许EMS代理 管理员将新药物添加到HMD应用程序中。在SA 2中，我们将检查HMD的可用性 应用程序和相关的桌面程序在基于模拟的环境中与最终用户的样本， 检查任务持续时间、认知负荷和错误率，并进行任何必要的改进。在SA 3中，我们将 在基于模拟的随机对照试验中测试HMD的应用，以检查其安全性和有效性， 使用EMS。这将产生一种安全有效的工具来缓解脆弱的EMS中的这一令人震惊的问题 儿科人群。

Project Summary The objective of this project is to develop a safe and effective dynamic cognitive aid application for use through a head-mounted display (HMD), to reduce error rates associated with pediatric medication administration (PMA) by emergency medical services (EMS). This objective will be achieved by examining characteristics associated with PMA, using a design thinking process to develop a prototype application, examining usability of the prototype, and testing the safety and efficacy in a randomized controlled trial. Errors associated with PMA in EMS are alarmingly high. Numerous studies have shown that there is a 31% error rate across all drugs administered to children by EMS. Medications such as midazolam and fentanyl have even higher rates at 61% and 65%, respectfully, with many being 10-fold errors. Sadly, previous strategies have had little impact on reducing error rates below 31%. System changes have failed due to inconsistencies in EMS systems, and challenges associated with medication shortages. Previously developed cognitive aids have fallen short often due to the fact they generally act as simple reference tools and do not address all causes of error associated with PMA. As a result, we are proposing the most comprehensive design process ever taken to combat this issue, utilizing advanced technology, to implement a dynamic cognitive aid to help providers improve dosing accuracy during PMA. We hypothesize that PMA errors in EMS will be significantly reduced by this application due to the comprehensive and rigorous design thinking process we will utilize followed by a randomized controlled trial to test safety and efficacy. Our interdisciplinary team will combine the fields of pediatric emergency medicine, EMS, engineering, computer science and user interface/user experience to address this issue with the support and effort of two medical schools in Michigan. In SA1 we will develop a prototype application. This will begin with identifying user and contextual information associated with PMA, and examine failure modes, root causes, and a task analysis of the procedure. We will then proceed into a comprehensive design thinking process to develop the application. During this process we will also create a desktop program that will allow EMS agency administrators to add new medications to the HMD application. In SA2, we will examine usability of the HMD application and associated desktop program in a simulation-based environment with a sample of end users, examining task duration, cognitive load and error rates and make any necessary refinements. In SA3, we will test the HMD application in a simulation-based randomized controlled trial to examine its safety and efficacy for use in EMS. This will result in a safe and effective tool to mitigate this alarming issue in the vulnerable EMS pediatric population.