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Comparing the Effectiveness of a Clinical Decision Support Tool in Reducing Pediatric Opioid Dose Calculation Errors:
Clyde T Matava1,2, Martina Bordini3,4,5, Amanda Jasudavisius3,6
1Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada. clyde.matava@sickkids.ca.
Insights
The PediPain app significantly reduced medication errors in pediatric pain management compared to traditional calculators. This clinical decision support tool improves accuracy and efficiency in calculating drug dosages for children.
Area of Science:
- Pediatric pharmacology and medication safety
- Clinical decision support systems
- Health informatics
Background:
- Medication errors, particularly wrong dose calculations, are a significant concern in pediatric care, often stemming from weight-based dosing complexities.
- Accurate and timely medication dosage calculation is critical for effective pain management in children.
Purpose of the Study:
- To evaluate the effectiveness of the PediPain app, a clinical decision support tool, in reducing medication calculation errors for pediatric analgesics.
- To compare the incidence of wrong dose calculations and the time required using the PediPain app versus pocket calculators.
Main Methods:
- A randomized controlled trial involving 140 healthcare providers (residents, fellows, nurses) performing eight weight-based analgesic dosage calculations.
- Participants were allocated to either the PediPain app (intervention group) or a pocket calculator (control group).
- Primary outcome: incidence of wrong dose calculations. Secondary outcomes included calculation time and error types.
Main Results:
- The PediPain app group demonstrated a significantly lower incidence of wrong dose calculations (4.23%) compared to the control group (30.9%), P < 0.001.
- Dosage calculations were faster with the PediPain app (median 48 seconds) than with pocket calculators (median 69 seconds), P < 0.001.
- The app showed significant risk reduction for both complex (-32.8%) and simple (-20.5%) calculations.
Conclusions:
- The PediPain app, a weight-based clinical decision support tool, effectively reduces medication calculation errors in pediatric pain management.
- Clinical decision support tools for medication calculations are valuable for minimizing medication errors in the pediatric population.
Abstract:
Wrong dose calculation medication errors are widespread in pediatric patients mainly due to weight-based dosing. PediPain app is a clinical decision support tool that provides weight- and age- based dosages for various analgesics. We hypothesized that the use of a clinical decision support tool, the PediPain app versus pocket calculators for calculating pain medication dosages in children reduces the incidence of wrong dosage calculations and shortens the time taken for calculations. The study was a randomised controlled trial comparing the PediPain app vs. pocket calculator for performing eight weight-based calculations for opioids and other analgesics. Participants were healthcare providers routinely administering opioids and other analgesics in their practice. The primary outcome was the incidence of wrong dose calculations. Secondary outcomes were the incidence of wrong dose calculations in simple versus complex calculations; time taken to complete calculations; the occurrence of tenfold; hundredfold errors; and wrong-key presses. A total of 140 residents, fellows and nurses were recruited between June 2018 and November 2019; 70 participants were randomized to control group (pocket calculator) and 70 to the intervention group (PediPain App). After randomization two participants assigned to PediPain group completed the simulation in the control group by mistake. Analysis was by intention-to-treat (PediPain app = 68 participants, pocket calculator = 72 participants). The overall incidence of wrong dose calculation was 178/576 (30.9%) for the control and 23/544 (4.23%) for PediPain App, P < 0·001. The risk difference was - 32.8% [-38.7%, -26.9%] for complex and - 20.5% [-26.3%, -14.8%] for simple calculations. Calculations took longer within control group (median of 69 Sects. [50, 96]) compared to PediPain app group, (median 48 Sects. [38, 63]), P < 0.001. There were no differences in other secondary outcomes. A weight-based clinical decision support tool, the PediPain app reduced the incidence of wrong doses calculation. Clinical decision support tools calculating medications may be valuable instruments for reducing medication errors, especially in the pediatric population.
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