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Disaster drill exercise documentation and management: are we drilling to standard?
Ilene Claudius1, Solomon Behar, Shana Ballow
1Department of Pediatrics and Division of Emergency Medicine, Childrens Hospital Los Angeles, and Keck School of Medicine, University of Southern California, Los Angeles, Calif 90027, USA.
Introduction:
Medical errors are known to occur even in a controlled setting with adequate resources. The few studies on mass-casualty events and disaster exercises suggest errors may be amplified in these situations. We hypothesized that both the documentation and medical care provided during a pediatric disaster drill would be substandard when compared with routine care at the same institution.
Methods:
Charts from the disaster exercise and matched charts from actual admitted patients were retrospectively reviewed for the presence of triage classification, allergies, weight, physical exam, vital signs, diagnosis, disposition time, disposition location, disposition instructions, and disposition vitals signs and for the appropriateness of diagnoses, medications, procedures, and disposition. Errors were quantified and classified into negligible, likely to cause temporary harm, or potential to cause admission or permanent harm. The drill charts were compared to actual charts by Fischer's Exact Test.
Results:
Drill charts contained a significantly greater proportion of errors in regards to performance of procedures, administration of medication, and accuracy of diagnosis. Sixteen percent of these errors were judged as having the potential to cause permanent harm or admission. The exercise charts contained a significantly greater number of omissions in documentation in 9 of the 10 areas evaluated.
Discussion:
Both the documentation and the quality of care provided during our exercise were deficient when compared with conventional care. Opportunities allowing providers to clearly document pertinent information, and linking of this documentation to relevant prompts and algorithms may minimize this potential for error.
Insights
Pediatric disaster drills revealed significant deficiencies in medical documentation and care quality compared to routine care. Errors in procedures, medications, and diagnoses during drills had the potential for serious harm.
Area of Science:
- Medical simulation
- Disaster medicine
- Patient safety
Background:
- Medical errors occur even in controlled settings.
- Mass-casualty events and disaster exercises may amplify errors.
- Pediatric disaster drills are crucial for preparedness.
Purpose of the Study:
- To compare the quality of medical documentation and care during a pediatric disaster drill versus routine care.
- To quantify and classify errors in both scenarios.
Main Methods:
- Retrospective review of charts from a disaster exercise and matched actual patient charts.
- Evaluation of 10 key documentation areas and appropriateness of diagnoses, medications, and procedures.
- Quantification and classification of errors; statistical comparison using Fischer's Exact Test.
Main Results:
- Drill charts showed significantly more errors in procedure performance, medication administration, and diagnostic accuracy.
- Sixteen percent of drill errors had the potential for permanent harm or admission.
- Drill charts had significantly more documentation omissions in 9 of 10 evaluated areas.
Conclusions:
- Both documentation and quality of care during the pediatric disaster drill were deficient compared to conventional care.
- Improving documentation clarity and linking it to prompts/algorithms may reduce errors.
- Findings highlight areas for improvement in disaster preparedness training.
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