Larose Guylaine, Levy Arielle, Bailey Benoit, Cummins-McManus Barbara, Lebel Denis, Gravel Jocelyn
Division of Emergency Medicine, Department of Pediatrics and
Division of Emergency Medicine, Department of Pediatrics and.
Pediatrics. 2017 Mar;139(3). doi: 10.1542/peds.2016-3200.
To evaluate whether a clinical aid providing precalculated medication doses decreases prescribing errors among residents during pediatric simulated cardiopulmonary arrest and anaphylaxis.
A crossover randomized trial was conducted in a tertiary care hospital simulation center with residents rotating in the pediatric emergency department. The intervention was a reference book providing weight-based precalculated doses. The control group used a card providing milligram-per-kilogram doses. The primary outcome was the presence of a prescribing error, defined as a dose varying by ≥20% from the recommended dose or by incorrect route. Residents were involved in 2 sets of paired scenarios and were their own control group. Primary analysis was the difference in mean prescribing error proportions between both groups.
Forty residents prescribed 1507 medications or defibrillations during 160 scenarios. The numbers of prescribing errors per 100 bolus medications or defibrillations were 5.1 (39 out of 762) and 7.5 (56 out of 745) for the intervention and control, respectively, a difference of 2.4 (95% confidence interval [CI], -0.1 to 5.0). However, the intervention was highly associated with lower risk of 10-fold error for bolus medications (odds ratio 0.27; 95% CI, 0.10 to 0.70). For medications administered by infusion, prescribing errors occurred in 3 out of 76 (4%) scenarios in the intervention group and 13 out of 76 (22.4%) in the control group, a difference of 13% (95% CI, 3 to 23).
A clinical aid providing precalculated medication doses was not associated with a decrease in overall prescribing error rates but was highly associated with a lower risk of 10-fold error for bolus medications and for medications administered by continuous infusion.
评估一种提供预先计算好的药物剂量的临床辅助工具是否能减少住院医师在儿科模拟心肺复苏和过敏反应期间的处方错误。
在一家三级护理医院模拟中心进行了一项交叉随机试验，住院医师在儿科急诊科轮转。干预措施是一本提供基于体重预先计算好的剂量的参考书。对照组使用一张提供每千克毫克剂量的卡片。主要结局是处方错误的存在，定义为剂量与推荐剂量相差≥20%或给药途径错误。住院医师参与了2组配对场景，且他们自身为对照组。主要分析是两组之间平均处方错误比例的差异。
40名住院医师在160个场景中开出了1507剂药物或进行了除颤操作。每100剂推注药物或除颤操作的处方错误数量，干预组为5.1（762剂中有39剂），对照组为7.5（745剂中有56剂），差异为2.4（95%置信区间[CI]，-0.1至5.0）。然而，干预措施与推注药物出现10倍剂量错误的较低风险高度相关（比值比0.27；95%CI，0.10至0.70）。对于通过输注给药的药物，干预组76个（4%）场景中有3个出现处方错误，对照组76个（22.4%）场景中有13个出现处方错误，差异为13%（95%CI，3%至23%）。
一种提供预先计算好的药物剂量的临床辅助工具与总体处方错误率的降低无关，但与推注药物以及持续输注给药的药物出现10倍剂量错误的较低风险高度相关。
