Assessment of the Accuracy and Effectiveness of Pediatric Drug Dosing Tools used by Paramedics
Introduction/Rationale: Studies of prehospital emergency pediatric care report frequent miscalculation of drug dosing. The Broselow Tape, a medication dosing reference guide, is used during emergencies to predict children’s weight according to their length. Dosing errors commonly occur when providers convert weight from pounds to kilograms, calculate dosages from a weight-based formula, or calculate volumes required to deliver specific medication doses. The Michigan Medication Emergency Dosing and Intervention Card (MI-MEDICard), a new dosing tool, reduces the need for multiple mathematical conversions. This study was designed to assess differences in dosing errors among paramedics when using the MI-MEDICard in comparison to the Broselow Tape during hypothetical pediatric emergency scenarios. Materials and Methods: Ninety-nine paramedics from five EMS agencies representing urban, suburban and rural response areas completed written tests utilizing the MI-MEDICard and the Broselow tape. Study subjects were randomly assigned into groups varying the order in which the tools were utilized. A crossover study design method was used. Analysis was conducted on the scores from each test and the order in which the dosing tools were used. Results: Average total errors were 5.63 (±1.56) per study subject with using the Broselow Tape and 1.52 (±1.61) using the MI-MEDICard. The maximum total number of errors possible was 9. Error rate reductions by dosing scenario were: epinephrine for cardiac arrest (52%), epinephrine for anaphylaxis (96%), dextrose 25% (94%), adenosine (38%), midazolam (58%), diphenhydramine (68%), morphine (83%), and fentanyl (66%). Discussion: Paramedics have to make decisions quickly, in extremely uncontrolled environments. Such environments are unstable due to, among other factors, emotional escalation, personal safety, scene safety and security, and time pressures. These factors increase stress on the provider and can reduce (or eliminate) clear thinking and skill retention needed for proper patient care. Pediatric medication dosing has been recognized as a high-error activity with the potential to cause serious harm. The MI-MEDICard was designed in hopes to reduce pediatric medication errors and has become a mandatory standard piece of equipment on each advanced life support vehicle in Michigan by MDHHS. However, requiring the use of the MI-MEDICard is only a first step toward assuring a reduction in pediatric medication errors. Conclusion: The use of the MI-MEDICard produced a 73% reduction in pediatric drug dosing errors. The results of this study demonstrate that supplementing the Broselow Tape with MI-MEDICard should result in a reduction in pediatric medication dosing errors.