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A Mobile Device App to Reduce Time to Drug Delivery and Medication Errors During Simulated Pediatric Cardiopulmonary
Johan N Siebert1, Frederic Ehrler2, Christophe Combescure3
1Department of Pediatric Emergency Medicine, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland.
Insights
The Pediatric Accurate Medication in Emergency Situations (PedAMINES) app significantly reduced drug preparation and delivery times and eliminated medication errors during simulated pediatric cardiopulmonary resuscitation (CPR). This mobile tool enhances medication safety in critical pediatric emergencies.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Informatics
- Medication Safety
Background:
- Pediatric cardiopulmonary resuscitation (CPR) involves complex vasoactive drug preparation, increasing medication error risk.
- Conventional methods are time-consuming, potentially compromising patient outcomes.
- An evidence-based, ergonomic approach led to the development of the PedAMINES mobile app.
Purpose of the Study:
- To evaluate the efficacy of the PedAMINES app in reducing drug preparation time (TDP) and time to delivery (TDD).
- To assess the impact of PedAMINES on medication error rates during continuous infusion preparation in pediatric emergencies.
- To compare PedAMINES with conventional infusion rate tables.
Main Methods:
- A randomized controlled crossover trial was conducted using a simulation-based pediatric CPR scenario.
- Pediatric emergency nurses prepared continuous infusions using either PedAMINES or conventional methods.
- Outcomes measured included TDP, TDD, and medication dosage error rates.
Main Results:
- PedAMINES reduced mean TDP by 180 seconds (128.1s vs 308.1s, P=.002).
- Mean TDD was reduced by 177.3 seconds with PedAMINES (214s vs 391s, P=.002).
- Medication errors decreased from 70% to 0% with PedAMINES (P<.001).
Conclusions:
- The PedAMINES app significantly decreases drug preparation and delivery times.
- PedAMINES effectively eliminates medication errors in simulated pediatric emergency drug preparation.
- This mobile application enhances safety and efficiency in critical pediatric care settings.
Background:
During pediatric cardiopulmonary resuscitation (CPR), vasoactive drug preparation for continuous infusion is both complex and time-consuming, placing children at higher risk than adults for medication errors. Following an evidence-based ergonomic-driven approach, we developed a mobile device app called Pediatric Accurate Medication in Emergency Situations (PedAMINES), intended to guide caregivers step-by-step from preparation to delivery of drugs requiring continuous infusion.
Objective:
The aim of our study was to determine whether the use of PedAMINES reduces drug preparation time (TDP) and time to delivery (TDD; primary outcome), as well as medication errors (secondary outcomes) when compared with conventional preparation methods.
Methods:
The study was a randomized controlled crossover trial with 2 parallel groups comparing PedAMINES with a conventional and internationally used drugs infusion rate table in the preparation of continuous drug infusion. We used a simulation-based pediatric CPR cardiac arrest scenario with a high-fidelity manikin in the shock room of a tertiary care pediatric emergency department. After epinephrine-induced return of spontaneous circulation, pediatric emergency nurses were first asked to prepare a continuous infusion of dopamine, using either PedAMINES (intervention group) or the infusion table (control group), and second, a continuous infusion of norepinephrine by crossing the procedure. The primary outcome was the elapsed time in seconds, in each allocation group, from the oral prescription by the physician to TDD by the nurse. TDD included TDP. The secondary outcome was the medication dosage error rate during the sequence from drug preparation to drug injection.
Results:
A total of 20 nurses were randomized into 2 groups. During the first study period, mean TDP while using PedAMINES and conventional preparation methods was 128.1 s (95% CI 102-154) and 308.1 s (95% CI 216-400), respectively (180 s reduction, P=.002). Mean TDD was 214 s (95% CI 171-256) and 391 s (95% CI 298-483), respectively (177.3 s reduction, P=.002). Medication errors were reduced from 70% to 0% (P<.001) by using PedAMINES when compared with conventional methods.
Conclusions:
In this simulation-based study, PedAMINES dramatically reduced TDP, to delivery and the rate of medication errors.
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