Improving Pediatric Medication Safety Through Implementation of Evidence-Based Guidelines.

Area of Science:

• Emergency medicine
• Pediatric critical care
• Quality improvement science

Background:

• Pediatric medication dosing errors are prevalent in prehospital settings, especially during critical events.
• Weight-based calculations pose a significant challenge for accurate dosing.
• Evidence-based guidelines recommend standardized weight estimation, volume-based dosing, cognitive offload tools, and clinician training.

Purpose of the Study:

• To implement evidence-based guidelines across an emergency medical services (EMS) system.
• To achieve at least 95% correct dosing for initial pediatric medication administration.
• To reduce medication errors in pediatric emergency care.

Main Methods:

• A quality improvement initiative guided by the Model for Improvement was conducted in an EMS system.
• Interventions included a volume-based dosing application, standardized length-based weight estimation, and hands-on training.
• Performance was monitored using Shewhart p-charts and Individual (I) charts, with ongoing case review for iterative improvements.

Main Results:

• Baseline dosing accuracy was 79% (2020-2022), with midazolam for seizures being the most frequent error (65% correct).
• Median correct dosing increased to 91% post-implementation, with sustained improvement to 97% by December 2025.
• Targeted retraining and application redesign enhanced accuracy, particularly for route-specific dosing.

Conclusions:

• Improving pediatric medication safety in EMS necessitates a comprehensive, collaborative, and iterative quality management approach.
• Sustained high performance requires continuous monitoring, targeted interventions, and system-level collaboration.
• Effective implementation of evidence-based tools, coupled with robust quality infrastructure, ensures reliable and durable improvements in pediatric medication safety.