Prehosp Emerg Care. 2020 Mar-Apr;24(2):204-213. doi: 10.1080/10903127.2019.1619002. Epub 2019 Jun 10.
Drug dosing errors occur at a high rate for prehospital pediatric patients. To reduce errors, Michigan implemented a state-wide pediatric dosing reference (PDR), with doses listed in milliliters, the requirement that doses be drawn into a smaller syringe from a pre-loaded syringe using a stopcock, and dilution of certain drugs to different concentrations. To evaluate the rate of medication errors, including errors of omission and commission, after implementation of a state-wide PDR. EMS crews from 15 agencies completed 4 validated, simulation scenarios: an infant seizing, an infant cardiac arrest, an 18-month-old with a burn, and 5-year-old with anaphylactic shock. Agencies were private, public, not-for-profit, for-profit, urban, rural, fire-based, and third service. EMS crews used their regular equipment and were required to carry out all the steps to administer a drug dose. Two evaluators scored crew performance via direct observation and video review. An error was defined as [Formula: see text]20% difference compared to the weight-appropriate dose. Descriptive statistics were utilized. A total of 142 simulations were completed. The majority of crews were (58.3%) Emergency Medical Technician-Paramedic (EMTP)/EMTP. For the cardiac arrest scenario, 51/70 (72.9%; 95% CI: 60.9%, 82.8%) epinephrine doses were correct. There were 6 (8.6%, 95% CI: 2.0%, 15.1%) 10-fold overdoses and one (1.4%; 95% CI: -1.4%, 4.2%), 10-fold under dose. In the seizure scenario, 28/50 (56.0%; 95% CI: 42.2%, 69.8%) benzodiazepine doses were correct; 6/18 (33.3%; 95% CI: 11.5%, 55.1%) drug dilutions were incorrect resulting in dosing errors. Unrecognized air was frequently entrained into the administration syringe resulting in under doses. Overall, 31.2% (95% CI: 25.5%, 36.6%) of drug doses were incorrect. Obtaining an incorrect weight led to a drug dosing error in 18/142 (12.7%, 95% CI: 7.2%, 18.2%) cases. Errors of omission included failure to check blood sugar in the seizure scenario and failure to administer epinephrine and a fluid bolus in anaphylactic shock. Despite implementation of a PDR, dosing errors, including 10-fold errors, still occur at a high rate. Errors occur with dilution and length-based tape use. Further error reduction strategies, beyond a PDR and that target errors of omission, are needed for pediatric prehospital drug administration.
在院前儿科患者中，药物剂量错误的发生率很高。为了减少错误，密歇根州实施了全州儿科剂量参考（PDR），剂量以毫升表示，要求使用三通阀从预装注射器中抽取较小的注射器，并对某些药物进行稀释至不同浓度。
评估实施全州 PDR 后药物错误（包括遗漏和错误）的发生率。来自 15 个机构的 EMS 工作人员完成了 4 个经过验证的模拟场景：婴儿抽搐、婴儿心脏骤停、18 个月大的烧伤和 5 岁的过敏性休克。机构是私人的、公共的、非营利的、营利的、城市的、农村的、基于消防的和第三方服务。EMS 工作人员使用他们的常规设备，并被要求执行给药剂量的所有步骤。两名评估员通过直接观察和视频审查对机组人员的表现进行评分。错误被定义为[公式：见文本]与体重相适应的剂量相差 20%。采用描述性统计。共完成 142 次模拟。大多数机组人员为（58.3%）急救医疗技术员-医师（EMTP）/EMTP。对于心脏骤停场景，70 份肾上腺素剂量中有 51 份（72.9%；95%置信区间：60.9%，82.8%）是正确的。有 6 份（8.6%；95%置信区间：2.0%，15.1%）是 10 倍过量，1 份（1.4%；95%置信区间：-1.4%，4.2%）是 10 倍不足。在抽搐场景中，50 份苯二氮䓬剂量中有 28 份（56.0%；95%置信区间：42.2%，69.8%）是正确的；18 份药物稀释中有 6 份（33.3%；95%置信区间：11.5%，55.1%）不正确，导致给药错误。经常将未识别的空气混入给药注射器中，导致剂量不足。总体而言，31.2%（95%置信区间：25.5%，36.6%）的药物剂量不正确。由于获得错误的体重，在 142 例中导致 18 例（12.7%；95%置信区间：7.2%，18.2%）药物剂量错误。遗漏错误包括在抽搐场景中未检查血糖，以及在过敏性休克中未给予肾上腺素和液体冲击。
尽管实施了 PDR，但仍以高频率发生包括 10 倍错误在内的给药错误。错误发生在稀释和基于长度的胶带使用中。在院前儿科药物管理方面，需要进一步的错误减少策略，而不仅仅是 PDR 和针对遗漏错误的策略。
