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Published on: November 9, 2016
An Analysis of Prehospital Pediatric Medication Dosing Errors after Implementation of a State-Wide EMS Pediatric Drug
Rasha Kazi1, John D Hoyle2, Cuyler Huffman2
1Children's Hospital of Michigan, Detroit, Michigan.
Background:
Medication dosing errors are common in prehospital pediatric patients. Prior work has shown the overall medication error rate by emergency medical services (EMS) in Michigan was 34.7%. To reduce these errors, the state of Michigan implemented a pediatric dosing reference in 2014 listing medication doses and volume to be administered.
Objective:
To examine changes in pediatric dosing errors by EMS in Michigan after implementation of the pediatric dosing reference.
Methods:
We conducted a retrospective review of the Michigan Emergency Medical Services Information System of children ≤ 12 years of age from June 2016-May 2017 treated by 16 EMS agencies. Agencies were a mix of public, private, third-service, and fire-based. A dosing error was defined as >20% deviation from the weight-appropriate dose listed on the pediatric dosing reference. Descriptive statistics with confidence intervals and standard deviations are reported.
Results:
During the study period, there were 9,247 pediatric encounters, of whom 727 (7.9%) received medications and are included in the study. There were 1078 medication administrations, with 380 dosing errors (35.2% [95% CI 25.3-48.4]). The highest error rates were for dextrose 50% (3/4 or 75% [95% CI 32.57-100.0]) and glucagon (3/4 or 75% [95% CI 32.57-100.0]). The next highest proportions of incorrect doses were opioids: intranasal fentanyl (11/16 or 68.8% [95% CI 46.04-91.46]) and intravenous fentanyl (89/130 or 68.5% [95% CI 60.47-76.45]). Morphine had a much lower error rate (24/51 or 47.1% [95% CI 33.36-60.76]). Midazolam had the third highest error rate, for intravenous (27/50 or 54.0% [95% CI (40.19-67.81]) and intramuscular (25/68 or 36.8% [95% CI 40.19-67.81]) routes. Epinephrine 1 mg/10 ml had an incorrect dosage rate of 35/119 (29.4% [95% CI 20.64-36.99]). Asthma medications had the lowest rate of incorrect dosing (albuterol sulfate 9/247 or 3.6% [95% CI 1.31-5.98]).
Conclusions:
Medications administered to prehospital pediatric patients continue to demonstrate dosing errors despite pediatric dosing reference implementation. Although there have been improvements in error rates in asthma medications, the overall error rate has increased. Continued work to build patient safety strategies to reduce pediatric medication dosing errors by EMS is needed.
Insights
Pediatric medication dosing errors persist in prehospital care, with a 35.2% error rate observed despite a dosing reference. Continued efforts are crucial to enhance patient safety strategies for emergency medical services (EMS).
Area of Science:
- Emergency medicine
- Pediatric critical care
- Health services research
Background:
- Medication dosing errors are prevalent in pediatric emergency medical services (EMS).
- A previous study indicated a 34.7% medication error rate in Michigan EMS.
- Michigan implemented a pediatric dosing reference in 2014 to mitigate these errors.
Purpose of the Study:
- To evaluate the impact of a statewide pediatric dosing reference on medication dosing errors in prehospital pediatric care.
- To identify specific medications with high error rates in pediatric EMS.
Main Methods:
- Retrospective review of the Michigan Emergency Medical Services Information System (MI-EMSIS) data.
- Analysis of pediatric encounters (≤ 12 years) from June 2016 to May 2017.
- Dosing error defined as >20% deviation from the reference dose; descriptive statistics reported.
Main Results:
- 35.2% of 1078 medication administrations had dosing errors.
- Highest error rates observed for dextrose 50% (75%), glucagon (75%), and fentanyl (68.8% intranasal, 68.5% IV).
- Albuterol sulfate showed the lowest error rate (3.6%).
Conclusions:
- Despite the pediatric dosing reference, significant medication dosing errors persist in prehospital pediatric care.
- While some medications like albuterol sulfate showed improvement, the overall error rate increased.
- Enhanced patient safety strategies are necessary to further reduce pediatric medication dosing errors by EMS.
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