Children's Hospital of Michigan, Detroit, Michigan.
Western Michigan University Homer Stryker School of Medicine, Kalamazoo, Michigan.
Prehosp Emerg Care. 2024;28(1):43-49. doi: 10.1080/10903127.2022.2162648. Epub 2023 Feb 1.
Medication dosing errors are common in prehospital pediatric patients. Prior work has shown the overall medication error rate by emergency medical services (EMS) in Michigan was 34.7%. To reduce these errors, the state of Michigan implemented a pediatric dosing reference in 2014 listing medication doses and volume to be administered.
To examine changes in pediatric dosing errors by EMS in Michigan after implementation of the pediatric dosing reference.
We conducted a retrospective review of the Michigan Emergency Medical Services Information System of children ≤ 12 years of age from June 2016-May 2017 treated by 16 EMS agencies. Agencies were a mix of public, private, third-service, and fire-based. A dosing error was defined as >20% deviation from the weight-appropriate dose listed on the pediatric dosing reference. Descriptive statistics with confidence intervals and standard deviations are reported.
During the study period, there were 9,247 pediatric encounters, of whom 727 (7.9%) received medications and are included in the study. There were 1078 medication administrations, with 380 dosing errors (35.2% [95% CI 25.3-48.4]). The highest error rates were for dextrose 50% (3/4 or 75% [95% CI 32.57-100.0]) and glucagon (3/4 or 75% [95% CI 32.57-100.0]). The next highest proportions of incorrect doses were opioids: intranasal fentanyl (11/16 or 68.8% [95% CI 46.04-91.46]) and intravenous fentanyl (89/130 or 68.5% [95% CI 60.47-76.45]). Morphine had a much lower error rate (24/51 or 47.1% [95% CI 33.36-60.76]). Midazolam had the third highest error rate, for intravenous (27/50 or 54.0% [95% CI (40.19-67.81]) and intramuscular (25/68 or 36.8% [95% CI 40.19-67.81]) routes. Epinephrine 1 mg/10 ml had an incorrect dosage rate of 35/119 (29.4% [95% CI 20.64-36.99]). Asthma medications had the lowest rate of incorrect dosing (albuterol sulfate 9/247 or 3.6% [95% CI 1.31-5.98]).
Medications administered to prehospital pediatric patients continue to demonstrate dosing errors despite pediatric dosing reference implementation. Although there have been improvements in error rates in asthma medications, the overall error rate has increased. Continued work to build patient safety strategies to reduce pediatric medication dosing errors by EMS is needed.
在院前儿科患者中，用药剂量错误很常见。先前的研究表明，密歇根州的紧急医疗服务（EMS）的总体用药错误率为 34.7%。为了减少这些错误，密歇根州在 2014 年实施了儿科剂量参考，列出了要给予的药物剂量和体积。
在密歇根州实施儿科剂量参考后，检查 EMS 儿科剂量错误的变化。
我们对 2016 年 6 月至 2017 年 5 月期间 16 个 EMS 机构治疗的≤12 岁儿童的密歇根州紧急医疗服务信息系统进行了回顾性研究。这些机构包括公共、私人、第三方服务和消防机构。剂量错误定义为与儿科剂量参考中列出的体重适当剂量相差>20%。报告描述性统计数据和置信区间和标准偏差。
在研究期间，有 9247 例儿科患者就诊，其中 727 例（7.9%）接受了药物治疗，并纳入了本研究。有 1078 次药物给药，其中 380 次（35.2%[95%CI 25.3-48.4%]）出现剂量错误。错误率最高的是 50%葡萄糖（3/4 或 75%[95%CI 32.57-100.0]）和胰高血糖素（3/4 或 75%[95%CI 32.57-100.0]）。其次是不正确剂量的阿片类药物：鼻内芬太尼（11/16 或 68.8%[95%CI 46.04-91.46%]）和静脉内芬太尼（89/130 或 68.5%[95%CI 60.47-76.45%]）。吗啡的错误率要低得多（24/51 或 47.1%[95%CI 33.36-60.76%]）。咪达唑仑的错误率第三高，静脉内（27/50 或 54.0%[95%CI 40.19-67.81%]）和肌内（25/68 或 36.8%[95%CI 40.19-67.81%]）途径。肾上腺素 1mg/10ml 的剂量错误率为 35/119（29.4%[95%CI 20.64-36.99%]）。哮喘药物的错误剂量率最低（沙丁胺醇硫酸盐 9/247 或 3.6%[95%CI 1.31-5.98%]）。
尽管实施了儿科剂量参考，但在院前儿科患者中继续存在用药剂量错误。尽管哮喘药物的错误率有所改善，但总体错误率有所增加。需要继续努力制定患者安全策略，以减少 EMS 儿科用药剂量错误。
