A Pediatric Medication Dosing Support Tool Increases Rates and Safety of Medication Delivery

Background: Pediatric patients represent 13% of all EMS transports, and only approximately 10% of pediatric patients transported are critically ill or injured requiring parenteral medication administration. This low exposure rate of critically ill children increases the risk of medication administration errors. Medication administration is further complicated by a weight-based schema. Technology support that addresses medication-dosing errors in pediatric care holds the potential to significantly increase pediatric patient safety. The goal of this study was to evaluate the medication dosing error rates before and after deployment of the Handtevy age-based system in a large metropolitan fire-based EMS system.

Methods: This was an interrupted time series comparing three months (Q1 2016) prior to the deployment of a pediatric dosing support tool (period 1) with the three months (Q1 2018) following full implementation (period 2). Criteria: All pediatric patients (≤13 years old) treated for pain or seizure. Medication dosing errors were defined as greater than 10% medication deviation from the correct mg/kg dose. Descriptive statistics and chi square were used to compare periods 1 and 2.

Results: A total of 133 pediatric patients were enrolled in this study, 51 in period 1 and 82 in period 2. Mean age was 8 ± 3 years for period 1 and 6 ± 4 in period 2 (p=0.003). The observed error rate was greater than expected, 72% and 82% for fentanyl and midazolam, respectively for period 1. Ninety percent of the errors were by underdosing patients. Error rates for period two were 41% and 36% for fentanyl and midazolam, respectively, with 69% being underdosing (p<0.001). 

Conclusions: Post deployment of the Handtevy pediatric drug dosing support application was correlated with a younger cohort and 61% increase in the overall rate of pediatric patients receiving pain or antiepileptic medications. Using a very conservative definition of a doing error (10% over or under ideal dosage per kg), the intervention resulted in a 42% reduction in overall dosing error.