Recent research has demonstrated that medication errors pose the greatest risks and consequences in critical care settings, where patients are sicker and lack the resilience to respond adequately to adverse events, and clinicians are under stress. What’s more, critical care patients typically receive twice as many medications as patients on general floors.
Studies also have shown that at least 25 percent of all harmful adverse drug events (ADEs) are preventable, and each preventable ADE adds a significant amount to the cost of a hospital stay. As such, the need for accurate and quick medication dosing is essential, particularly in the emergency setting, and even more particularly in the presence of children, when doses usually are not pre-drawn like they would be for adults. Specifically, one study that reviewed the charts of more than 1,500 children seen in the emergency department of a children’s hospital found that prescribing errors occurred in 10 percent of those charts. Another study revealed that during mock pediatric emergencies, 17 percent of medication orders were incomplete, and 16 percent of prepared doses were incorrect by at least 20 percent. Seven percent of those doses were incorrect by at least 50 percent.
To this end, a research study, “Medication Preparation in Pediatric Emergencies: Comparison of a Bar Code-Enabled System and a Traditional Approach,” conducted by the University of Kentucky and released by the Journal of Pediatric Pharmacology and Therapeutics, has found that the use of a web- and mobile-based medication reference tool from Raleigh, N.C.-based eBroselow increased the accuracy of medication doses prepared during simulated pediatric emergencies by nearly 25 percent, and completely eliminated clinically significant errors. The research also showed that use of the system, as compared to traditional processes, reduced the time required to prepare medication during an emergency.
Dr. Jim Broselow invented eBroselow—first offered to hospitals in 2010—to standardize the administration of medications used during adult and pediatric emergencies, a process that is prone to substantial errors. The medication reference tool serves as a double-check for doctors, nurses and pharmacists, and removes the complicated math involved in many dosing decisions. With the tool, medical professionals can quickly determine the proper medicine doses for both adult and child patients based on weight, specific medical indication and other factors. The system also provides preparation and administration content for medications in an intuitive visual system.
The University of Kentucky study conducted at the Department of Pharmacy Practice and Science at Kentucky Children’s Hospital in Lexington aimed to compare accuracy and timeliness of medication preparation during pediatric emergencies when using eBroselow compared with standard dosing references. “We are an academic medical center in Lexington with about 650 beds, so we have a huge emergency department for both adults and children,” says Robert Kuhn, Pharm.D., University of Kentucky College of Pharmacy and study author. “We thought it would be great to simulate the real-world situation of medication preparation using the online system versus the conventional way that nurses and pharmacists prepare medicines in a pediatric emergency situation,” he says.
For the study, 13 nurses, ranging in experience, volunteered at the university’s simulations lab, with each participant being assigned to either the intervention or control group during the first scenario, and switching groups in the second scenario. Participants in the intervention group were allowed to use eBroselow after a 10-minute tutorial; participants in the control group were allowed to use drug references normally available in the emergency department such as a traditional dosage handbook or card, Kuhn notes. Kuhn and his colleagues video recorded each of these sessions and subsequently analyzed where issues or medication breakdowns would take place. Nurses were penalized one minute if they had to ask a pharmacist about a dosage, because if a pharmacist wasn’t available in a real life situation, it would take the nurse longer than one minute to figure out what to do, Kuhn explains.
The first significant result from this study was that the online system increased the accuracy of medication doses prepared during simulated pediatric emergencies by nearly 25 percent. A 20 percent deviation from the recommended dose was used, meaning that if the recommended dose was 8 mg, the dose given had to be between 7.2 mg and 9.6 mg to be considered decent, though not precise, notes Kuhn. “Outside of this 20 percent range means that the medication could not have the desired effect, and can actually have a toxic effect,” he says.
Additionally, the average time it took the medication to prepare was 8 minutes faster with the online system than with standard preparation. “Eight minutes is a tremendous amount of time in a code situation,” says Kuhn. “Personally, I have been to at least 400 pediatric codes in my life, and every one is a special situation where time can be a big factor. Medication dosing, accuracy, and calculation is so important.”
What’s more, tenfold medication errors are a significant source of risk to pediatric patients because of wide variations in age, weight, dosing ranges, and off-label practice. In the heat of the battle in the ER, a major error such as 100x1 being written as 1,000 rather than 100 could have a drastic impact. “And this is not something that’s uncommon,” notes Kuhn. “But with eBroselow, the information is all generated off reading/scanning the barcode. Everything is right there on the screen and it’s all done within a second. You don’t have to calculate the dose, unlike with traditional methods,” he says.
Barcodes and QR codes on every virtual page— which displays drug mixing and administration information tailored for a specific indication and patient weight—allow quick lookup using barcode scanners and mobile devices. The system can be accessed right from the internet with an appropriate passcode, and can be integrated within the electronic medical record (EMR), Kuhn says, adding that eBroselow is currently being beta-tested in the university with the goal to extend it to other facilities. “We have proven that with this system, medication dosing safer and faster. If you can be accurate and fast in pediatric code, you have the best change of resuscitating and saving that baby’s life. That’s the bottom line.”