Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
Department of Anesthesiology and Pain Medicine, Faculty of Medicine, University of Toronto, Toronto, ON), Canada.
J Med Syst. 2024 Apr 17;48(1):43. doi: 10.1007/s10916-024-02060-4.
Wrong dose calculation medication errors are widespread in pediatric patients mainly due to weight-based dosing. PediPain app is a clinical decision support tool that provides weight- and age- based dosages for various analgesics. We hypothesized that the use of a clinical decision support tool, the PediPain app versus pocket calculators for calculating pain medication dosages in children reduces the incidence of wrong dosage calculations and shortens the time taken for calculations. The study was a randomised controlled trial comparing the PediPain app vs. pocket calculator for performing eight weight-based calculations for opioids and other analgesics. Participants were healthcare providers routinely administering opioids and other analgesics in their practice. The primary outcome was the incidence of wrong dose calculations. Secondary outcomes were the incidence of wrong dose calculations in simple versus complex calculations; time taken to complete calculations; the occurrence of tenfold; hundredfold errors; and wrong-key presses. A total of 140 residents, fellows and nurses were recruited between June 2018 and November 2019; 70 participants were randomized to control group (pocket calculator) and 70 to the intervention group (PediPain App). After randomization two participants assigned to PediPain group completed the simulation in the control group by mistake. Analysis was by intention-to-treat (PediPain app = 68 participants, pocket calculator = 72 participants). The overall incidence of wrong dose calculation was 178/576 (30.9%) for the control and 23/544 (4.23%) for PediPain App, P < 0·001. The risk difference was - 32.8% [-38.7%, -26.9%] for complex and - 20.5% [-26.3%, -14.8%] for simple calculations. Calculations took longer within control group (median of 69 Sects. [50, 96]) compared to PediPain app group, (median 48 Sects. [38, 63]), P < 0.001. There were no differences in other secondary outcomes. A weight-based clinical decision support tool, the PediPain app reduced the incidence of wrong doses calculation. Clinical decision support tools calculating medications may be valuable instruments for reducing medication errors, especially in the pediatric population.
在儿科患者中，由于基于体重的剂量计算错误，错误剂量计算的药物错误非常普遍。PediPain 应用程序是一种临床决策支持工具，可为各种镇痛药提供基于体重和年龄的剂量。我们假设，与使用口袋计算器相比，使用临床决策支持工具 PediPain 应用程序计算儿童疼痛药物剂量可降低错误剂量计算的发生率，并缩短计算时间。该研究是一项随机对照试验，比较了 PediPain 应用程序与口袋计算器在进行八种基于体重的阿片类药物和其他镇痛药计算时的效果。参与者是在实践中常规给予阿片类药物和其他镇痛药的医疗保健提供者。主要结果是错误剂量计算的发生率。次要结果是简单计算与复杂计算中错误剂量计算的发生率；完成计算所需的时间；十倍误差；百倍误差；以及错误键的按压。共有 140 名住院医师、研究员和护士于 2018 年 6 月至 2019 年 11 月期间被招募；70 名参与者被随机分配至对照组（口袋计算器）和 70 名干预组（PediPain App）。随机分组后，两名被分配至 PediPain 组的参与者错误地在对照组中完成了模拟。分析采用意向治疗（PediPain app = 68 名参与者，口袋计算器 = 72 名参与者）。对照组的错误剂量计算总发生率为 178/576（30.9%），而 PediPain App 为 23/544（4.23%），P < 0.001。风险差异为 -32.8%[-38.7%，-26.9%]，复杂计算为-20.5%[-26.3%，-14.8%]。与 PediPain app 组相比，对照组的计算时间更长（中位数为 69 秒[50，96]），（中位数为 48 秒[38，63]），P < 0.001。其他次要结果无差异。基于体重的临床决策支持工具 PediPain app 降低了错误剂量计算的发生率。计算药物的临床决策支持工具可能是减少药物错误的有价值工具，尤其是在儿科人群中。
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