Medication Errors in Pediatric Patients after Implementation of a Field Guide with Volume-Based Dosing

Area of Science:

• Emergency Medicine
• Pediatric Care
• Prehospital Services

Background:

• Pediatric medication errors are frequent among prehospital providers.
• A hospital-based urban EMS system introduced the Handtevy Field Guide in 2015.
• The guide provides precalculated pediatric doses in milliliters (mL) by patient age.

Purpose of the Study:

• To evaluate the impact of the Handtevy Field Guide on pediatric medication dosing accuracy.
• To determine if the implementation increased correct pediatric medication doses to over 85%.

Main Methods:

• Retrospective cohort study of pediatric patients (< 13 years) from August 2017 to July 2019.
• Compared medication administrations to 2014 baseline data using electronic medical records.
• Defined correct doses as 80-120% of the Field Guide recommendation; excluded nebulized and online-directed medications.

Main Results:

• Correct doses were administered in 89.4% of cases during the study period, up from 51.1% at baseline (p < 0.001).
• Specific medications like adenosine, dextrose 10%, and epinephrine 1:10,000 had 100% appropriate dosing.
• Medication errors included overdoses (4.4%) and underdoses (6.2%), with highest error rates in infants (0-1 year).

Conclusions:

• Implementation of a precalculated mL dose system by patient age improved pediatric medication administration accuracy.
• A field guide with precalculated doses is an effective tool for reducing pediatric medication dosing errors by EMS providers.