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Drug preparation and administration errors during simulated paediatric resuscitations
Sashen Murugan1, Pano Parris1, Mike Wells1
1Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Insights
Medication errors during pediatric resuscitation are common, particularly in drug withdrawal and administration phases. Using appropriately sized syringes can help reduce these critical drug preparation and administration errors in pediatric emergencies.
Area of Science:
- Pediatric Emergency Medicine
- Medication Safety
- Clinical Pharmacy
Background:
- Medication errors in pediatric care are a significant concern.
- Few studies have specifically addressed drug preparation and administration errors during pediatric resuscitation.
Purpose of the Study:
- To evaluate the frequency and nature of drug preparation and administration errors during simulated pediatric resuscitation.
Main Methods:
- Prospective observational study in a tertiary hospital's emergency department.
- Two-doctor teams prepared and administered medications during simulated pediatric emergencies.
- Video recording of preparation, collection of all materials, and analysis of deviations from intended volumes.
Main Results:
- Significant errors occurred in drug withdrawal (13/96 doses >20% error) and administration (20/96 doses >20% error).
- Median drug delivery time was 79 seconds.
- Largest errors resulted from using large syringes for small volumes.
Conclusions:
- Substantial errors in pediatric medication preparation and administration were identified.
- Targeted training for emergency nurses and doctors on pediatric medication handling is recommended.
- Optimizing syringe selection, using smaller syringes for smaller volumes, can mitigate errors.
Introduction:
Very few studies have assessed drug preparation and administration errors during paediatric resuscitation. Current evidence suggests that medication errors in paediatrics are a serious problem. The aim of this study was to evaluate drug preparation and administration errors incurred during the simulated resuscitation of paediatric patients.
Methods:
This was a prospective observational study performed in the emergency department of a tertiary-level hospital. Teams consisting of two emergency doctors were tasked with preparing and delivering medication during simulated emergency scenarios. Preparation processes were video recorded. All phials, syringes and administered volumes were collected and analysed to determine the accuracy of drug preparation and delivery. Deviations from intended volumes were calculated.
Main Results:
A total of 96 dosages were recorded from 24 participants. Most errors were identified in the withdrawal of drug phase (prior to dilution) (13 of 96 doses had a >20% error), and the administration of medication phase (20 of 96 doses had a >20% error). Overall the median time taken to deliver each drug was 79 s (IQR 59, 100 s). The largest percentage errors were seen when a large syringe was used to withdraw or administer a small volume of medication.
Conclusion:
The study clearly demonstrated that there were significant errors in the preparation and administration of medication. Training in the preparation and administration of paediatric medications should be available for all emergency nurses and doctors. Correct syringe choice may reduce these errors-smaller syringes should be used for withdrawing or administering smaller volumes.
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