281 The Impact of Documenting Patient Weight in Kilograms on Pediatric Medication Dosing Errors in Emergency Medical Services

Abstract

Up to 40% of children who receive a medication from emergency medical services (EMS) are subject to a dosing error. The reasons for this are multifactorial but include difficulties adjusting drug dosages for patient weight. The conversion of patient weight from pounds to kilograms compounds this latent safety threat. In 2014 the National Highway Traffic Safety Administration launched the EMS Compass Project. One of three pediatric performance improvement measures was the proportion of children who received a weight-based medicine from EMS who had a weight documented in kilograms. This was also included in the initial National EMS Quality Alliance (NEMSQA) Measure Set. Despite inclusion in these benchmarks, there is little direct evidence that EMS documentation of a weight in kilograms is associated with lower rates of pediatric medication dosing errors. Our primary objective was to determine whether EMS documentation of a weight in kilograms was associated with a lower rate of pediatric medication dosing errors. We conducted a cross-sectional study using the 2016-17 Maryland state EMS database. We included all patients aged 0-14 years old who received a weight-based medication. Using validated age-based formulas, we assigned a weight (+/- 20% sensitivity margin) to patients who did not have one documented. Medication doses were classified as errors and severe errors if they deviated from the state protocol dose by > 20% or > 50% respectively. We used chi-squared tests to compare the proportion of medication dosage errors for children with and without a documented weight. We completed sub-analyses for the most commonly administered medications and by patient age group. We identified 3,618 eligible cases of medication administration. 1,927 (53%) of these records had a documented weight (Figure 1). Patients with a documented weight had a significantly lower overall rate of medication dosing errors when compared to those without (22 vs. 26%, p < .05) (Table 1). A sensitivity analysis where we assigned a weight to those patients with a weight recorded did not significantly change this result. Only epinephrine (34 vs. 56%, p < .05) and fentanyl (10 vs. 31%, p < .05) had significantly lower rates of medication dosing errors for patients with a documented weight. Infants had the highest rate of medication dosing errors. They were the only age group where documenting a weight was associated with a significantly lower dosing error rate (33% vs. 53%. P < .05) (Table 2). A limitation of our study is that we only had access to a limited dataset and could not analyze for confounding variables associated with dosing errors. Our overall rates of pediatric dosing error by EMS are lower than previously reported. Our findings suggest that documenting a weight in kilograms is associated with a small but significantly lower pediatric medication dosing errors rate. Our results show that documenting a weight in kilograms is particularly important for specific medications and patient age groups. Additional strategies (including age-based standardized dosing) may be needed to further reduce pediatric medication dosing errors by EMS.View Large Image Figure ViewerDownload Hi-res image Download (PPT)View Large Image Figure ViewerDownload Hi-res image Download (PPT)