A Cognitive Aid for Neonatal Epinephrine Dosing.

Area of Science:

• Medical Education
• Patient Safety
• Neonatal Resuscitation

Background:

• Epinephrine dosing errors are common during neonatal resuscitation due to complex calculations and multiple concentrations.
• Accurate epinephrine preparation is critical for effective neonatal resuscitation outcomes.

Purpose of the Study:

• To evaluate the effectiveness of a printed cognitive aid in reducing epinephrine preparation errors.
• To assess the impact of the cognitive aid on dosing accuracy and efficiency during simulated neonatal resuscitation.

Main Methods:

• A randomized controlled trial involving 100 nurses preparing epinephrine doses for simulated neonatal resuscitation.
• Nurses were assigned to use or not use a cognitive aid, with preparation scenarios video-recorded and analyzed for errors.
• Outcomes included incorrect dose preparation, incorrect concentration selection, and preparation time.

Main Results:

• The cognitive aid significantly decreased incorrect epinephrine dose preparation (24% vs 50%, P = .01).
• Errors in selecting the correct epinephrine concentration were also significantly reduced (12% vs 44%, P < .001).
• No significant difference was observed in the time to prepare the dose or errors in the written intended dose.

Conclusions:

• A simple cognitive aid effectively reduces epinephrine dosing errors in simulated neonatal resuscitation.
• Despite improvements, errors were not entirely eliminated, indicating a persistent safety risk for newborns.
• Additional interventions are necessary to completely mitigate epinephrine preparation errors in neonatal resuscitation.