Objectives: We sought to decrease pediatric prehospital dosing errors by implementing a bundled drug dosing safety system (DDSS). Multiple studies have demonstrated that pediatric prehospital drug-dosing errors occur at rates of > 30% for all drugs.
Methods: We used a quality improvement (QI) design and instituted a DDSS in emergency medical services (EMS) agencies that included bi-monthly online pediatric drug dosing training, a pediatric drug dosing checklist, a length-based tape with no drug references, patient weight relayed to the crew from dispatch and a drug dosing reference in the ambulance cab. Comparison agencies continued their usual processes. Four simulation cases: infant cardiac arrest, infant seizure with hypoglycemia, child anaphylaxis and child burn were carried out before and 27 months after DDSS implementation in both groups. Descriptive statistics with p values and relative risks were calculated.
Results: There was no significant difference in the drug dosing error rate for the QI intervention group (65.6% correct) vs the comparison group (67.2% correct) p = 0.84 relative risk = 0.98. In the anaphylaxis case, there were significantly fewer errors of omission in the QI intervention group, (73.7% vs 21.4% correct, p = 0.005). There were three large overdoses of D10 in the seizure case (830%, 557%, and 540%), which may have been fatal to a real patient. All occurred by attaching the D10 intravenous (IV) line to the patient's IV instead of drawing the needed volume into a syringe. Crews in the QI intervention group that used the pediatric drug dosing checklist had significantly fewer dosing errors (80.8% correct) vs those that did not (53.3% correct) p = 0.015.
Conclusions: A multi-component DDSS did not improve drug dosing error rates. It did demonstrate a decrease in errors of omission for anaphylaxis. The QI intervention crews who used the DDSS checklist had significantly lower drug dosing error rates. Further study of checklists and additional strategies are needed for error reduction. This study identified a serious, potentially fatal, latent safety threat-the administration of D10 to pediatric patients. System-based interventions such as replacing D10 with D10 normal saline are needed.