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Effect of a Mobile App on Prehospital Medication Errors During Simulated Pediatric Resuscitation: A Randomized
Johan N Siebert1,2, Laurie Bloudeau3, Christophe Combescure4
1Department of Pediatric Emergency Medicine, Geneva Children's Hospital, Geneva University Hospitals, Geneva, Switzerland.
Insights
A mobile app significantly reduced medication errors in pediatric emergencies, decreasing errors by 66.5% and speeding up drug delivery. This innovation shows promise for improving prehospital emergency care safety.
Area of Science:
- Emergency Medicine
- Clinical Pharmacology
- Health Informatics
Background:
- Medication errors are a significant cause of preventable harm, particularly in pediatric emergency care.
- There is a lack of innovative interventions to prevent medication errors in prehospital settings.
- Children are especially vulnerable to medication errors.
Purpose of the Study:
- To evaluate the effectiveness of an evidence-based mobile application in minimizing medication errors during simulated pediatric out-of-hospital cardiac arrest scenarios.
- To compare the app's performance against conventional drug preparation methods.
Main Methods:
- A nationwide, open-label, multicenter randomized clinical trial involving 150 advanced paramedics across 14 Swiss emergency medical services centers.
- Participants prepared 4 intravenous emergency drugs in simulated pediatric cardiac arrest scenarios.
- Randomization to either a mobile app for drug preparation assistance or conventional methods.
Main Results:
- The mobile app group had a significantly lower rate of medication errors (5.7%) compared to the conventional method group (62.8%).
- The app reduced medication errors by 66.5% and decreased drug preparation and delivery times.
- Medication error rates varied across drugs, with the app consistently showing lower risks.
Conclusions:
- Mobile applications can significantly decrease medication errors and improve drug delivery times in prehospital emergency settings.
- Dedicated mobile apps hold potential for enhancing medication safety and transforming practices in pediatric emergency medicine.
Importance:
Medication errors are a leading cause of injury and avoidable harm, affecting millions of people worldwide each year. Children are particularly susceptible to medication errors, but innovative interventions for the prevention of these errors in prehospital emergency care are lacking.
Objective:
To assess the efficacy of an evidence-based mobile app in reducing the occurrence of medication errors compared with conventional preparation methods during simulated pediatric out-of-hospital cardiac arrest scenarios.
Design, Setting, And Participants:
This nationwide, open-label, multicenter, randomized clinical trial was conducted at 14 emergency medical services centers in Switzerland from September 3, 2019, to January 21, 2020. The participants were 150 advanced paramedics with drug preparation autonomy. Each participant was exposed to a 20-minute, standardized, fully video-recorded, realistic pediatric out-of-hospital cardiac arrest cardiopulmonary resuscitation scenario concerning an 18-month-old child. Participants were tested on sequential preparations of 4 intravenous emergency drugs of varying degrees of preparation difficulty (epinephrine, midazolam, 10% dextrose, and sodium bicarbonate).
Intervention:
Participants were randomized (1:1 ratio) to the support of an app designed to assist with pediatric drug preparation (intervention; n = 74) or to follow conventional drug preparation methods without assistance (control; n = 76).
Main Outcomes And Measures:
The primary outcome was the rate of medication errors, defined as a failure in drug preparation according to predefined, expert consensus-based criteria. Logistic regression models with mixed effects were used to assess the effect of the app on binary outcomes. Secondary outcomes included times to drug preparation and delivery, assessed with linear regression models with mixed effects.
Results:
In total, 150 advanced paramedics (mean [SD] age, 35.6 [7.2] years; 101 men [67.3%]; mean [SD] time since paramedic certification, 8.0 [6.2] years) participated in the study and completed 600 drug preparations. Of 304 preparations delivered using the conventional method, 191 (62.8%; 95% CI, 57.1%-68.3%) were associated with medication errors compared with 17 of 296 preparations delivered using the app (5.7%; 95% CI, 3.4%-9.0%). When accounting for repeated measures, with the app, the proportion of medication errors decreased in absolute terms by 66.5% (95% CI, 32.6%-83.8%; P < .001), the mean time to drug preparation decreased by 40 seconds (95% CI, 23-57 seconds; P < .001), and the mean time to drug delivery decreased by 47 seconds (95% CI, 27-66 seconds; P < .001). The risk of medication errors varied across drugs with conventional methods (19.7%-100%) when compared with the app (4.1%-6.8%).
Conclusions And Relevance:
Compared with conventional methods, the use of a mobile app significantly decreased the rate of medication errors and time to drug delivery for emergency drug preparation in a prehospital setting. Dedicated mobile apps have the potential to improve medication safety and change practices in pediatric emergency medicine.
Trial Registration:
ClinicalTrials.gov Identifier: NCT03921346.
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