Assessing the Influence of a Statewide Dosing Reference Aid on Prehospital Pediatric Medication Dosing Errors: A...

Area of Science:

• Emergency medicine
• Pediatric critical care
• Medication safety

Background:

• Prehospital pediatric medication administrations (PMA) have a high error rate (31%) in Michigan.
• Existing reference aids like MI-MEDIC may not fully address the root causes of these dosing errors.

Purpose of the Study:

• To investigate the frequency, magnitude, and immediate causes of PMA dosing errors.
• To evaluate the effectiveness of the MI-MEDIC pediatric dosing reference aid in reducing errors.

Main Methods:

• A mixed-method, simulation-based approach was used with emergency medical services (EMS) crews.
• High-fidelity simulations of pediatric emergencies were conducted, requiring medication administrations.
• Post-simulation interviews and a modified Delphi method were employed to analyze errors and their causes.

Main Results:

• Dosing errors occurred in 28.8% of administrations, with underdosing being more frequent (68.4%).
• Median underdose was 0.50, and median overdose was 2.00.
• Identified causes included incorrect weight (21%), air in syringes (31.6%), and improper medication dilution (31.6%) per the reference aid.

Conclusions:

• High rates of PMA dosing errors persist even with the MI-MEDIC reference aid.
• Current aids do not address critical error sources like incorrect weight, air in syringes, or dilution issues.
• Further research is needed to develop comprehensive strategies to mitigate identified active errors in pediatric medication safety.