Downstream Medication Dosing Errors Associated With Three Different Methods To Obtain Weights On Prehospital Pediatric Patients
INTRODUCTION: Multiple studies have shown pediatric prehospital dosing errors occur at a high rate. The overall error rate, despite references that eliminate math, is 30%. The first step in accurate drug dosing is obtaining a weight. In the prehospital environment, this must be estimated since paramedics rarely have access to a scale. We sought to describe the methods used to obtain weight and their associated errors.
METHODS: As part of a quality improvement study, crews from 16 EMS agencies completed 4 validated, simulation scenarios: infant seizure, 8-month old burn, 5-year old anaphylactic shock and infant cardiac arrest. EMS crews used their regular equipment with sham drugs and were required to carry out all the steps to administer a drug dose. Two evaluators scored crew performance via direct observation and video review. A dose error was defined as >= 20% difference compared to the weight-appropriate dose. Descriptive statistics were utilized.
RESULTS: There were 137 simulations. Methods used to obtain weight were: asking the parent (AP) 17 (12.4%), length-based tape (LBT) 87 (63.5%) and age 32 (23.4%). The associated drug dosing error rates were: AP (1/17 5.8% 95% CI: -5.3%,16.9%), LBT (16/87 18.4%, 95% CI 10.3%-26.5%) and age (10/32 31.3%, 95% CI 15.23% to 47.37%).
CONCLUSION: Asking the parent for a weight was associated with the lowest downstream drug dosing error rate. Using a weight determination hierarchy with asking the parent for a weight first should be considered in order to decrease prehospital pediatric medication dosing errors.