一款用于减少模拟儿科心肺复苏期间药物送达时间和用药错误的移动设备应用程序：一项随机对照试验。
A Mobile Device App to Reduce Time to Drug Delivery and Medication Errors During Simulated Pediatric Cardiopulmonary Resuscitation: A Randomized Controlled Trial.
作者信息
Siebert Johan N, Ehrler Frederic, Combescure Christophe, Lacroix Laurence, Haddad Kevin, Sanchez Oliver, Gervaix Alain, Lovis Christian, Manzano Sergio
机构信息
Department of Pediatric Emergency Medicine, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland.
Department of Radiology and Medical Informatics, Division of Medical Information Sciences, University Hospitals of Geneva, Geneva, Switzerland.
出版信息
J Med Internet Res. 2017 Feb 1;19(2):e31. doi: 10.2196/jmir.7005.
BACKGROUND
During pediatric cardiopulmonary resuscitation (CPR), vasoactive drug preparation for continuous infusion is both complex and time-consuming, placing children at higher risk than adults for medication errors. Following an evidence-based ergonomic-driven approach, we developed a mobile device app called Pediatric Accurate Medication in Emergency Situations (PedAMINES), intended to guide caregivers step-by-step from preparation to delivery of drugs requiring continuous infusion.
OBJECTIVE
The aim of our study was to determine whether the use of PedAMINES reduces drug preparation time (TDP) and time to delivery (TDD; primary outcome), as well as medication errors (secondary outcomes) when compared with conventional preparation methods.
METHODS
The study was a randomized controlled crossover trial with 2 parallel groups comparing PedAMINES with a conventional and internationally used drugs infusion rate table in the preparation of continuous drug infusion. We used a simulation-based pediatric CPR cardiac arrest scenario with a high-fidelity manikin in the shock room of a tertiary care pediatric emergency department. After epinephrine-induced return of spontaneous circulation, pediatric emergency nurses were first asked to prepare a continuous infusion of dopamine, using either PedAMINES (intervention group) or the infusion table (control group), and second, a continuous infusion of norepinephrine by crossing the procedure. The primary outcome was the elapsed time in seconds, in each allocation group, from the oral prescription by the physician to TDD by the nurse. TDD included TDP. The secondary outcome was the medication dosage error rate during the sequence from drug preparation to drug injection.
RESULTS
A total of 20 nurses were randomized into 2 groups. During the first study period, mean TDP while using PedAMINES and conventional preparation methods was 128.1 s (95% CI 102-154) and 308.1 s (95% CI 216-400), respectively (180 s reduction, P=.002). Mean TDD was 214 s (95% CI 171-256) and 391 s (95% CI 298-483), respectively (177.3 s reduction, P=.002). Medication errors were reduced from 70% to 0% (P<.001) by using PedAMINES when compared with conventional methods.
CONCLUSIONS
In this simulation-based study, PedAMINES dramatically reduced TDP, to delivery and the rate of medication errors.
背景
在儿科心肺复苏（CPR）期间，用于持续输注的血管活性药物准备工作既复杂又耗时，使儿童比成人面临更高的用药错误风险。遵循基于证据的人体工程学驱动方法，我们开发了一款移动设备应用程序，名为儿科紧急情况下准确用药（PedAMINES），旨在指导护理人员从需要持续输注药物的准备到给药的全过程。
目的
我们研究的目的是确定与传统准备方法相比，使用PedAMINES是否能减少药物准备时间（TDP）和给药时间（TDD；主要结局）以及用药错误（次要结局）。
方法
该研究是一项随机对照交叉试验，有两个平行组，在持续药物输注准备过程中，将PedAMINES与传统且国际通用的药物输注速率表进行比较。我们在一家三级护理儿科急诊科的休克室中，使用高保真人体模型模拟儿科CPR心脏骤停场景。在肾上腺素诱导自主循环恢复后，首先要求儿科急诊护士使用PedAMINES（干预组）或输注表（对照组）准备多巴胺持续输注，其次，通过交叉操作准备去甲肾上腺素持续输注。主要结局是每个分配组从医生口头处方到护士给药的用时（以秒为单位）。给药时间包括药物准备时间。次要结局是从药物准备到药物注射过程中的用药剂量错误率。
结果
共有20名护士被随机分为两组。在第一个研究阶段，使用PedAMINES和传统准备方法时的平均药物准备时间分别为128.1秒（95%可信区间102 - 154）和308.1秒（95%可信区间216 - 400）（减少180秒，P = 0.002）。平均给药时间分别为214秒（95%可信区间171 - 256）和391秒（95%可信区间298 - 483）（减少177.3秒，P = 0.002）。与传统方法相比，使用PedAMINES时用药错误从70%降至0%（P < 0.001）。
结论
在这项基于模拟的研究中，PedAMINES显著减少了药物准备时间、给药时间和用药错误率。
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