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NAEMSP Position Statement and Resource Document

Medication Dosing Safety for Pediatric Patients: Recognizing Gaps, Safety Threats, and Best Practices in the Emergency Medical Services Setting. A Position Statement and Resource Document from NAEMSP

Pages 294-306 | Received 15 Jan 2020, Accepted 03 Jul 2020, Published online: 27 Aug 2020

References

  • Shah MN, Cushman JT, Davis CO, Bazarian JJ, Auinger P, Friedman B. The epidemiology of emergency medical services use by children: an analysis of the National Hospital Ambulatory Medical Care Survey. Prehosp Emerg Care. 2008;12(3):269–76. doi:10.1080/10903120802100167.
  • Kannikeswaran N, Mahajan PV, Dunne RB, Compton S, Knazik SR. Epidemiology of pediatric transports and non-transports in an urban Emergency Medical Services system. Prehosp Emerg Care. 2007;11(4):403–7. doi:10.1080/10903120701536677.
  • Lerner EB, Dayan PS, Brown K, Fuchs S, Leonard J, Borgialli D, Babcock L, Hoyle JD, Jr, Kwok M, Lillis K, for the Pediatric Emergency Care Applied Research Network (PECARN), et al. Characteristics of the pediatric patients treated by the Pediatric Emergency Care Applied Research Network's affiliated EMS agencies. Prehosp Emerg Care. 2014;18(1):52–9. doi:10.3109/10903127.2013.836262.
  • Lammers R, Byrwa M, Fales W. Root causes of errors in a simulated prehospital pediatric emergency. Acad Emerg Med. 2012;19(1):37–47. doi:10.1111/j.1553-2712.2011.01252.x.
  • Hoyle JD, Crowe RP, Bentley MA, Beltran G, Fales W. Pediatric prehospital medication dosing errors: a national survey of paramedics. Prehosp Emerg Care. 2017;21(2):185–91. doi:10.1080/10903127.2016.1227001.
  • Lim CAE, Kaufman BJ, O’Connor J, Cunningham SJ. Accuracy of weight estimates in pediatric patients by prehospital emergency medical services personnel. Am J Emerg Med. 2013;31(7):1108–12. doi:10.1016/j.ajem.2013.04.018.
  • McDowell SE, Ferner HS, Ferner RE. The pathophysiology of medication errors: how and where they arise. Br J Clin Pharmacol. 2009;67(6):605–13. doi:10.1111/j.1365-2125.2009.03416.x.
  • Hoyle JD, Davis AT, Putman KK, Trytko JA, Fales WD. Medication dosing errors in pediatric patients treated by emergency medical services. Prehosp Emerg Care. 2012;16(1):59–66. doi:10.3109/10903127.2011.614043.
  • Hoyle JD, Ekblad G, Hover T, Woodwyk A, Brandt R, Fales B, Lammers RL. Dosing errors made by paramedics during pediatric patient simulations after implementation of a state-wide pediatric drug dosing reference. Prehosp Emerg Care. 2020;24(2):204–213. doi:10.1080/10903127.2019.1619002.
  • Huang X, Lin J, Demner-Fushman D. Evaluation of PICO as a knowledge representation for clinical questions. AMIA Annu Symp Proc. 2006;359–63.
  • Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Open Med. 2009;3(3):e123–e130.
  • Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, Schünemann HJ, GRADE Working Group. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336(7650):924–6. doi:10.1136/bmj.39489.470347.AD.
  • Luten R, Wears RL, Broselow J, Croskerry P, Joseph MM, Frush K. Managing the unique size-related issues of pediatric resuscitation: reducing cognitive load with resuscitation aids. Acad Emerg Med. 2002;9(8):840–7. doi:10.1197/aemj.9.8.840.
  • Bernius M, Thibodeau B, Jones A, Clothier B, Witting M. Prevention of pediatric drug calculation errors by prehospital care providers. Prehosp Emerg Care. 2008;12(4):486–94. doi:10.1080/10903120802290752.
  • Kaji AH, Gausche-Hill M, Conrad H, Young KD, Koenig WJ, Dorsey E, Lewis RJ. Emergency medical services system changes reduce pediatric epinephrine dosing errors in the prehospital setting. Pediatrics. 2006;118(4):1493–500. doi:10.1542/peds.2006-0854.
  • Shah AN, Frush K, Luo X, Wears RL. Effect of an intervention standardization system on pediatric dosing and equipment size determination: a crossover trial involving simulated resuscitation events. Arch Pediatr Adolesc Med. 2003;157(3):229–36. doi:10.1001/archpedi.157.3.229.
  • Wells M, Coovadia A, Kramer E, Goldstein L. The PAWPER tape: a new concept tape-based device that increases the accuracy of weight estimation in children through the inclusion of a modifier based on body habitus. Resuscitation. 2013;84(2):227–32. doi:10.1016/j.resuscitation.2012.05.028.
  • Rappaport LD, Brou L, Givens T, Mandt M, Balakas A, Roswell K, Kotas J, Adelgais KM. Comparison of errors using two length-based tape systems for prehospital care in children. Prehosp Emerg Care. 2016;20(4):508–17. doi:10.3109/10903127.2015.1128027.
  • Haffey F, Brady RR, Maxwell S. A comparison of the reliability of smartphone apps for opioid conversion. Drug Saf. 2013;36(2):111–7. doi:10.1007/s40264-013-0015-0.
  • Siebert JN, Ehrler F, Combescure C, Lacroix L, Haddad K, Sanchez O, Gervaix A, Lovis C, Manzano S. A mobile device app to reduce time to drug delivery and medication errors during simulated pediatric cardiopulmonary resuscitation: a randomized controlled trial. J Med Internet Res. 2017;19(2):e31. doi:10.2196/jmir.7005.
  • Low D, Clark N, Soar J, Padkin A, Stoneham A, Perkins GD, Nolan J. A randomised control trial to determine if use of the iResus© application on a smart phone improves the performance of an advanced life support provider in a simulated medical emergency. Anaesthesia. 2011;66(4):255–62. doi:10.1111/j.1365-2044.2011.06649.x.
  • Dingley J, Cromey C, Bodger O, Williams D. Evaluation of 2 novel devices for calculation of fluid requirements in pediatric burns. Ann Plast Surg. 2015;74(6):658–64.
  • Appelbaum N, Clarke J, Maconochie I, Darzi A. Paediatric weight estimation by age in the digital era: optimising a necessary evil. Resuscitation. 2018;122:29–35. doi:10.1016/j.resuscitation.2017.11.041.
  • Vilke GM, Marino A, Fisher R, Chan TC. Estimation of pediatric patient weight by EMT-PS. J Emerg Med. 2001;21(2):125–8. doi:10.1016/S0736-4679(01)00354-7.
  • Chassee T, Reischmann D, Mancera M, Hoyle JD. Emergency medical dispatchers can obtain accurate pediatric weights from 9-1-1 callers. Prehosp Emerg Care. 2016;20(6):808–14. doi:10.3109/10903127.2016.1168892.
  • Hoyle JD, Jr, Ekblad G, Hover T, Woodwyk A, Brandt R, Fales B, Lammers RL. Analysis of dosing errors made by paramedics during simulated pediatric patient scenarios after implementation of state-wide pediatric drug dosing reference. Prehosp Emerg Care. 2017;1–50.
  • Sinha M, Lezine MW, Frechette A, Foster KN. Weighing the pediatric patient during trauma resuscitation and its concordance with estimated weight using Broselow Luten Emergency Tape. Pediatr Emerg Care. 2012;28(6):544–7. doi:10.1097/PEC.0b013e318258ac2e.
  • Wong E, Taylor Z, Thompson J, Tuthill D. A simplified gentamicin dosing chart is quicker and more accurate for nurse verification than the BNFc. Arch Dis Child. 2009;94(7):542–5. doi:10.1136/adc.2007.137026.
  • Weighing all patients in kilograms. Pediatrics. 2017;140(4). https://pediatrics.aappublications.org/content/pediatrics/140/4/e20172476.full.pdf
  • Gerber M. How to measure and improve EMS systems. EMS compass is setting the profession on a path toward performance measurement and improvement. EMS World. 2016;45(1):24–6.
  • Shaw KN, Lillis KA, Ruddy RM, Mahajan PV, Lichenstein R, Olsen CS, Chamberlain JM. Reported medication events in a paediatric emergency research network: sharing to improve patient safety. Emerg Med J. 2013;30(10):815–9. doi:10.1136/emermed-2012-201642.
  • Wells M, Goldstein LN, Bentley A. The accuracy of emergency weight estimation systems in children-a systematic review and meta-analysis. Int J Emerg Med. 2017;10(1):29. doi:10.1186/s12245-017-0156-5.
  • Wells M, Goldstein LN. Optimising emergency weight estimation in underweight and obese children: the accuracy of estimations of total body weight and ideal body weight. Eur J Emerg Med. 2019;26(4):301–307.
  • Carasco CF, Fletcher P, Maconochie I. Review of commonly used age-based weight estimates for paediatric drug dosing in relation to the pharmacokinetic properties of resuscitation drugs. Br J Clin Pharmacol. 2016;81(5):849–56. doi:10.1111/bcp.12876.
  • Young KD, Korotzer NC. Weight estimation methods in children: a systematic review. Ann Emerg Med. 2016;68(4):441–51.e410. doi:10.1016/j.annemergmed.2016.02.043.
  • Krieser D, Nguyen K, Kerr D, Jolley D, Clooney M, Kelly AM. Parental weight estimation of their child's weight is more accurate than other weight estimation methods for determining children's weight in an emergency department? Emerg Med J. 2007;24(11):756–9. doi:10.1136/emj.2007.047993.
  • O'Leary F, John-Denny B, McGarvey K, Hann A, Pegiazoglou I, Peat J. Estimating the weight of ethnically diverse children attending an Australian emergency department: a prospective, blinded, comparison of age-based and length-based tools including Mercy, PAWPER and Broselow. Arch Dis Child. 2017;102(1):46–52. doi:10.1136/archdischild-2016-310917.
  • Hubble MW, Paschal KR, Sanders TA. Medication calculation skills of practicing paramedics. Prehosp Emerg Care. 2000;4(3):253–60. doi:10.1080/10903120090941290.
  • Eastwood K, Boyle MJ, Williams B. Mathematical and drug calculation abilities of paramedic students. Emerg Med J. 2013;30(3):241–2. doi:10.1136/emermed-2011-200929.
  • Eastwood K, Boyle MJ, Williams B. Undergraduate paramedic students cannot do drug calculations. World J Emerg Med. 2012;3(3):221–6. doi:10.5847/wjem.j.issn.1920-8642.2012.03.011.
  • Eastwood KJ, Boyle MJ, Williams B. Paramedics' ability to perform drug calculations. West J Emerg Med. 2009;10(4):240–3.
  • Boyle MJ, Eastwood K. Drug calculation ability of qualified paramedics: a pilot study. World J Emerg Med. 2018;9(1):41–5. doi:10.5847/wjem.j.1920-8642.2018.01.006.
  • Beilock SL, Carr TH. When high-powered people fail: working memory and “choking under pressure” in math. Psychol Sci. 2005;16(2):101–5. doi:10.1111/j.0956-7976.2005.00789.x.
  • Wolf OT. The influence of stress hormones on emotional memory: relevance for psychopathology. Acta Psychol (Amst). 2008;127(3):513–31. doi:10.1016/j.actpsy.2007.08.002.
  • Lupien SJ, Gillin CJ, Hauger RL. Working memory is more sensitive than declarative memory to the acute effects of corticosteroids: a dose-response study in humans. Behav Neurosci. 1999;113(3):420–30. doi:10.1037//0735-7044.113.3.420.
  • MA S. Stress, cognition, and human performance: a literature review and conceptual framework. https://ntrs.nasa.gov/citations/20060017835. Published 2004. Accessed November 25, 2019.
  • LeBlanc VR, MacDonald RD, McArthur B, King K, Lepine T. Paramedic performance in calculating drug dosages following stressful scenarios in a human patient simulator. Prehosp Emerg Care. 2005;9(4):439–44. doi:10.1080/10903120500255255.
  • Leblanc VR, Regehr C, Tavares W, Scott AK, Macdonald R, King K. The impact of stress on paramedic performance during simulated critical events. Prehosp Disaster Med. 2012;27(4):369–74. doi:10.1017/S1049023X12001021.
  • LeBlanc VR. The effects of acute stress on performance: implications for health professions education. Acad Med. 2009;84(10 Suppl):S25–S33. doi:10.1097/ACM.0b013e3181b37b8f.
  • Cushman JT, Fairbanks RJ, O'Gara KG, Crittenden CN, Pennington EC, Wilson MA, Chin NP, Shah MN. Ambulance personnel perceptions of near misses and adverse events in pediatric patients. Prehosp Emerg Care. 2010;14(4):477–84. doi:10.3109/10903127.2010.497901.
  • Cottrell EK, O'Brien K, Curry M, Meckler GD, Engle PP, Jui J, Summers C, Lambert W, Guise JM. Understanding safety in prehospital emergency medical services for children. Prehosp Emerg Care. 2014;18(3):350–8. doi:10.3109/10903127.2013.869640.
  • Wells M, Goldstein LN, Bentley A, Basnett S, Monteith I. The accuracy of the Broselow tape as a weight estimation tool and a drug-dosing guide - A systematic review and meta-analysis. Resuscitation. 2017;121:9–33. doi:10.1016/j.resuscitation.2017.09.026.
  • Nieman CT, Manacci CF, Super DM, Mancuso C, Fallon WF. Use of the Broselow tape may result in the underresuscitation of children. Acad Emerg Med. 2006;13(10):1011–9. doi:10.1197/j.aem.2006.06.042.
  • Lowe CG, Campwala RT, Ziv N, Wang VJ. The Broselow and Handtevy resuscitation tapes: a comparison of the performance of pediatric weight prediction. Prehosp Disaster Med. 2016;31(4):364–75. doi:10.1017/S1049023X16000455.
  • Lammers R, Willoughby-Byrwa M, Fales W. Medication errors in prehospital management of simulated pediatric anaphylaxis. Prehosp Emerg Care. 2014;18(2):295–304. doi:10.3109/10903127.2013.856501.
  • Park J, Kwak YH, Kim DK, Jung JY, Lee JH, Jang HY, Kim HB, Hong KJ. A new age-based formula for estimating weight of Korean children. Resuscitation. 2012;83(9):1129–34. doi:10.1016/j.resuscitation.2012.01.023.
  • Shah V, Bavdekar SB. Validity of Broselow tape for estimating weight of Indian children. Indian J Med Res. 2017;145(3):339–46.
  • Laraque D, Boscarino J, Battista A, Fleischman A, Casalino M, Hu Y, Ramos S, Adams RE, Schmidt J, Chemtob C. Reactions and needs of tristate-area pediatricians after the events of September 11th: implications for children's mental health services. Pediatrics. 2004;113(5):1357–66. doi:10.1542/peds.113.5.1357.
  • Fleischman RJ, Yarris LM, Curry MT, Yuen SC, Breon AR, Meckler GD. Pediatric educational needs assessment for urban and rural emergency medical technicians. Pediatr Emerg Care. 2011;27(12):1130–5.
  • Stevens SL, Alexander JL. The impact of training and experience on EMS providers' feelings toward pediatric emergencies in a rural state. Pediatr Emerg Care. 2005;21(1):12–7.
  • Su E, Schmidt T, Mann N, Zechnich A. A randomized controlled trial to assess decay in acquired knowledge among paramedics completing a pediatric resuscitation course. Acad Emerg Med. 2000;7(7):779–86. doi:10.1111/j.1553-2712.2000.tb02270.x.
  • Lammers RL, Willoughby-Byrwa M, Fales WD. Errors and error-producing conditions during a simulated, prehospital, pediatric cardiopulmonary arrest. Simul Healthc. 2014;9(3):174–83. doi:10.1097/SIH.0000000000000013.
  • Nahata MC, Powell DA, Glazer JP, Hilty MD. Effect of intravenous flow rate and injection site on in vitro delivery of chloramphenicol succinate and in vivo kinetics. J Pediatr. 1981;99(3):463–6. doi:10.1016/S0022-3476(81)80351-4.
  • Nahata MC, Powell DA, Durrell D, Glazer JP. Delivery of tobramycin by three infusion systems. Chemotherapy. 1984;30(2):84–7. doi:10.1159/000238251.
  • Abdallah C, Hannallah R, Patel K. MR-compatible pumps versus manual titration of propofol for pediatric sedation. J Med Eng Technol. 2010;34(7-8):443–7. doi:10.3109/03091902.2010.515286.
  • Weinberg E, Auerbach M, Shah N. The use of simulation for pediatric training and assessment. Curr Opin Pediatr. 2009;21(3):282–7. doi:10.1097/MOP.0b013e32832b32dc.
  • Bokhari R, Bollman-Mcgregor J, Kahol K, Smith M, Feinstein A, Ferrara J. Design, development, and validation of a take-home simulator for fundamental laparoscopic skills: using Nintendo Wii for surgical training. Am Surg. 2010;76(6):583–6. doi:10.1177/000313481007600620.
  • Frush K, Hohenhaus S, Luo X, Gerardi M, Wiebe RA. Evaluation of a web-based education program on reducing medication dosing error: a multicenter, randomized controlled trial. Pediatr Emerg Care. 2006;22(1):62–70. doi:10.1097/01.pec.0000195760.97199.7e.
  • Sarfati L, Ranchon F, Vantard N, Schwiertz V, Larbre V, Parat S, Faudel A, Rioufol C. Human-simulation-based learning to prevent medication error: A systematic review. J Eval Clin Pract. 2019;25(1):11–20. doi:10.1111/jep.12883.
  • Stevens AD, Hernandez C, Jones S, Moreira ME, Blumen JR, Hopkins E, Sande M, Bakes K, Haukoos JS. Color-coded prefilled medication syringes decrease time to delivery and dosing errors in simulated prehospital pediatric resuscitations: a randomized crossover trial. Resuscitation. 2015;96:85–91. doi:10.1016/j.resuscitation.2015.07.035.
  • Alsulami Z, Choonara I, Conroy S. Nurses' knowledge about the double-checking process for medicines administration. Nurs Child Young People. 2014;26(9):21–6. doi:10.7748/ncyp.26.9.21.e378.
  • Schwappach DL, Pfeiffer Y, Taxis K. Medication double-checking procedures in clinical practice: a cross-sectional survey of oncology nurses' experiences. BMJ Open. 2016;6(6):e011394. doi:10.1136/bmjopen-2016-011394.
  • Alsulami Z, Conroy S, Choonara I. Double checking the administration of medicines: what is the evidence? A systematic review. Arch Dis Child. 2012;97(9):833–7. doi:10.1136/archdischild-2011-301093.
  • Hewitt T, Chreim S, Forster A. Double checking: a second look. J Eval Clin Pract. 2016;22(2):267–74. doi:10.1111/jep.12468.
  • Ekmekjian T, Castiglione S. What evidence exists that describes whether manual double checks should be performed independently or synchronously to decrease the risk of medication administration error? August ed. Montreal, Quebec, Canada: McGill University Health Centre; 2017.
  • Institute for Safe Medication Practices. Independent double checks worth the effort if used judiciously and properly. https://www.ismp.org/resources/independent-double-checks-worth-effort-if-used-judiciously-and-properly [accessed 2019 Jun 06].
  • Misasi P, Keebler JR. Medication safety in emergency medical services: approaching an evidence-based method of verification to reduce errors. Ther Adv Drug Saf. 2019;10:2042098618821916. doi:10.1177/2042098618821916.
  • Hoyle JD, Sleight D, Henry R, Chassee T, Fales B, Mavis B. Pediatric prehospital medication dosing errors: a mixed-methods study. Prehosp Emerg Care. 2016;20(1):117–24. doi:10.3109/10903127.2015.1061625.
  • Chen SI, Fox ER, Hall MK, Ross JS, Bucholz EM, Krumholz HM, Venkatesh AK. Despite federal legislation, shortages of drugs used in acute care settings remain persistent and prolonged. Health Aff (Millwood). 2016;35(5):798–804. doi:10.1377/hlthaff.2015.1157.
  • Hawley KL, Mazer-Amirshahi M, Zocchi MS, Fox ER, Pines JM. Longitudinal trends in U.S. drug shortages for medications used in emergency departments (2001-2014). Acad Emerg Med. 2016;23(1):63–9. doi:10.1111/acem.12838.
  • Yang C, Cai W, Li Z, Page AT, Fang Y. The current status and effects of emergency drug shortages in China: perceptions of emergency department physicians. PLoS One. 2018;13(10):e0205238. doi:10.1371/journal.pone.0205238.
  • Skinner AC, Skelton JA. Prevalence and trends in obesity and severe obesity among children in the United States, 1999-2012. JAMA Pediatr. 2014;168(6):561–6. doi:10.1001/jamapediatrics.2014.21.
  • Callaghan LC, Walker JD. An aid to drug dosing safety in obese children: development of a new nomogram and comparison with existing methods for estimation of ideal body weight and lean body mass. Anaesthesia. 2015;70(2):176–82. doi:10.1111/anae.12860.

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