Division of Pediatric Emergency Medicine; University of Florida, Jacksonville, Florida, USA.
J Patient Saf. 2009 Jun;5(2):79-85. doi: 10.1097/PTS.0b013e3181a647ab.
To compare the performance of current systems in place for preparation and administration of pediatric medications in community emergency departments to the color-coded medication safety (CCMS) system among nurses.
Community ED nurses participated in simulated pediatric emergency scenarios using traditional dosing references then the CCMS system. We measured preintervention/postintervention: (1) time to task completion from physician order to medication administration; (2) accuracy of conversion to milliliters, dilution, and time for medication administration; and (3) recognition of 10-fold physician errors.
A total of 320 medication and infusion orders were given to 16 nurses. The median time to task completion preintervention was 109 seconds (interquartile range, 44-626). Time to task completion was reduced to a median of 28 seconds (interquartile range, 14-43; P < 0.001) with the CCMS system. Significant error reductions were noted when nurses used the CCMS system: 25.6% of medications were converted incorrectly compared with 2.5% with the system, a 23% improvement (95% confidence interval [CI], 13-33; P < 0.001), 35.6% were diluted incorrectly compared with 0.63%, a 35% improvement (95% CI, 26-44; P < 0.001), and 54.7% were administered incorrectly compared with 3.9%, a 51% improvement (95% CI, 39-61; P < 0.001). Only 20% of 10-fold physician order errors were recognized preintervention but 93% were recognized using the CCMS system, a 73% improvement.
The CCMS system reduces pediatric medication delay and improves nursing accuracy. This is important in the community ED setting where many children receive emergency care and where providers may lack familiarity with pediatric medication dosing.
比较社区急诊部门中当前用于准备和管理儿科药物的系统与护士使用的彩色编码药物安全（CCMS）系统的性能。
社区急诊护士使用传统剂量参考资料，然后使用 CCMS 系统参与模拟儿科急诊场景。我们测量了干预前/后：（1）从医生医嘱到给药的任务完成时间；（2）转换为毫升、稀释和给药时间的准确性；（3）识别 10 倍医生错误的能力。
共有 16 名护士处理了 320 个药物和输液医嘱。干预前任务完成的中位数时间为 109 秒（四分位距，44-626）。使用 CCMS 系统后，任务完成时间减少到中位数 28 秒（四分位距，14-43；P <0.001）。当护士使用 CCMS 系统时，显著减少了错误：与系统相比，25.6%的药物转换不正确，2.5%的药物转换正确，改善了 23%（95%置信区间[CI]，13-33；P <0.001），35.6%的药物稀释不正确，0.63%的药物稀释正确，改善了 35%（95% CI，26-44；P <0.001），54.7%的药物给药不正确，3.9%的药物给药正确，改善了 51%（95% CI，39-61；P <0.001）。干预前仅识别出 20%的 10 倍医生医嘱错误，但使用 CCMS 系统识别出 93%的错误，提高了 73%。
CCMS 系统可减少儿科药物延迟并提高护理准确性。这在许多儿童接受紧急护理的社区急诊环境中很重要，而且提供者可能不熟悉儿科药物剂量。
