Faculty for Health, University Witten/Herdecke, Witten.
Fire Department, Center of Emergency Medicine, City of Cologne, Cologne.
J Patient Saf. 2021 Dec 1;17(8):e1241-e1246. doi: 10.1097/PTS.0000000000000915.
The Pediatric Emergency Ruler (PaedER) is a height-based drug dose recommendation tool that was reported to reduce life-threatening medication errors by 90%. The PaedER was introduced into the Cologne Emergency Medical Service (EMS) in 2008 along with educational measures, publications, and lectures for pediatric drug safety. We reviewed the impact of these continuously ongoing measures on medication errors after 10 years.
The PaedER was introduced and distributed to all 14 emergency ambulances and 2 helicopters staffed with emergency physicians in the city of Cologne in November 2008. Electronic records and medical protocols of the Cologne EMS over two 20-month periods from March 2007 to October 2008 and March 2018 to October 2019 data sets were retrieved. The administered doses of either intravenous, intraosseous, intranasal, or buccal fentanyl, midazolam, ketamine, or epinephrine were recorded. Primary outcome measure was the rate of severe drug dosing errors with a deviation from the recommended dose of greater than 300%.
A total of 59 and 443 drug administrations were analyzed for 2007/08 and 2018/19, respectively. The overall rate of drug dosing errors decreased from 22.0% to 9.9% (P = 0.014; relative risk reduction, 55%). Four of 5 severe dosing errors for epinephrine were avoided (P < 0.021; relative risk reduction, 78%). Documentation of patient's weight increased from 3.2% in 2007/08 to 30.5% in 2018/19 (P < 0.001).
The distribution of the PaedER combined by educational measures significantly reduced the rates of life-threatening medication errors in a large EMS. Those results should motivate further initiatives on pediatric drug safety in prehospital emergency care.
儿科急诊用药尺（PaedER）是一种基于身高的药物剂量推荐工具，据报道，它将危及生命的用药错误减少了 90%。2008 年，PaedER 与儿童药物安全相关的教育措施、出版物和讲座一起被引入科隆急救医疗服务（EMS）。我们回顾了这些持续进行的措施在 10 年后对用药错误的影响。
2008 年 11 月，PaedER 被引入并分发给科隆市的 14 辆急救车和 2 架配备急诊医生的直升机。检索了 2007 年 3 月至 2008 年 10 月和 2018 年 3 月至 2019 年 10 月两个 20 个月期间科隆 EMS 的电子病历和医疗协议记录。记录了静脉、骨内、鼻内或颊部给予芬太尼、咪达唑仑、氯胺酮或肾上腺素的剂量。主要结局指标是严重药物剂量错误的发生率，即偏离推荐剂量超过 300%。
分别分析了 2007/08 年和 2018/19 年的 59 次和 443 次药物给药。药物剂量错误的总体发生率从 22.0%降至 9.9%（P=0.014；相对风险降低 55%）。避免了 4 例肾上腺素严重剂量错误（P<0.021；相对风险降低 78%）。患者体重的记录从 2007/08 年的 3.2%增加到 2018/19 年的 30.5%（P<0.001）。
在大型 EMS 中，PaedER 与教育措施相结合的分发显著降低了危及生命的用药错误率。这些结果应该激励在院前急救中开展更多的儿科药物安全倡议。
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