Abstract
BackgroundEmergency drug preparation and administration in children is both complex and time-consuming and places this population at a higher risk than adults for medication errors. Moreover, survival and a favorable neurological outcome from cardiopulmonary resuscitation are inversely correlated to drug preparation time. We developed a mobile device application (the pediatric Accurate Medication IN Emergency Situations (PedAMINES) app) as a step-by-step guide for the preparation to delivery of drugs requiring intravenous injection. In a previous multicenter randomized trial, we reported the ability of this app to significantly reduce in-hospital continuous infusion medication error rates and drug preparation time compared to conventional preparation methods during simulation-based pediatric resuscitations. This trial aims to evaluate the effectiveness of this app during pediatric out-of-hospital cardiopulmonary resuscitation.Methods/designWe will conduct a multicenter, prospective, randomized controlled trial to compare the PedAMINES app with conventional calculation methods for the preparation of direct intravenously administered emergency medications during standardized, simulation-based, pediatric out-of-hospital cardiac arrest scenarios using a high-fidelity manikin. One hundred and twenty paramedics will be randomized (1:1) in several emergency medical services located in different regions of Switzerland. Each paramedic will be asked to prepare, sequentially, four intravenously administered emergency medications using either the app or conventional methods. The primary endpoint is the medication error rates. Enrollment will start in mid-2019 and data analysis in late 2019. We anticipate that the intervention will be completed in early 2020 and study results will be submitted in late 2020 for publication (expected in early 2021).DiscussionThis clinical trial will assess the impact of an evidence-based mobile device app to reduce the rate of medication errors, time to drug preparation and time to drug delivery during prehospital pediatric resuscitation. As research in this area is scarce, the results generated from this study will be of great importance and may be sufficient to change and improve prehospital pediatric emergency care practice.Trial registrationClinicalTrials.gov, ID: NCT03921346. Registered on 18 April 2019.
Highlights
Emergency drug preparation and administration in children is both complex and time-consuming and places this population at a higher risk than adults for medication errors
Siebert et al Trials (2019) 20:634 (Continued from previous page). This clinical trial will assess the impact of an evidence-based mobile device app to reduce the rate of medication errors, time to drug preparation and time to drug delivery during prehospital pediatric resuscitation
As research in this area is scarce, the results generated from this study will be of great importance and may be sufficient to change and improve prehospital pediatric emergency care practice
Summary
Emergency drug preparation and administration in children is both complex and time-consuming and places this population at a higher risk than adults for medication errors. In a previous multicenter randomized trial, we reported the ability of this app to significantly reduce in-hospital continuous infusion medication error rates and drug preparation time compared to conventional preparation methods during simulation-based pediatric resuscitations. Most drugs given intravenously to children are provided in vials originally prepared for the adult population This leads to the need for a specific, individual, weight-based drug-dose calculation and preparation for each child that varies widely across age groups [3, 5,6,7,8,9]. The rate of errors is important in the high-risk prehospital setting, which is reported as occurring in more than 30% of all pediatric drugs administered, with an error rate for epinephrine dosage alone of more than 60% [13] In this particular context, initial care has to be delivered quickly by emergency medical services (EMS) in challenging field environments where resources and providers are limited [14]. As paramedics have little exposure to pediatric education during their initial training [15] and, thereafter, to critically ill children during their work hours [16], they have limited opportunities to administer resuscitation drugs at pediatric doses and to improve their skill level
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