Disaster drill exercise documentation and management: are we drilling to standard?
BACKGROUND
Medical errors are known to occur even in a controlled setting with adequate resources. The few studies on mass-casualty events and disaster exercises suggest errors may be amplified in these situations. We hypothesized that both the documentation and medical care provided during a pediatric disaster drill would be substandard when compared with routine care at the same institution.


METHODS
Charts from the disaster exercise and matched charts from actual admitted patients were retrospectively reviewed for the presence of triage classification, allergies, weight, physical exam, vital signs, diagnosis, disposition time, disposition location, disposition instructions, and disposition vitals signs and for the appropriateness of diagnoses, medications, procedures, and disposition. Errors were quantified and classified into negligible, likely to cause temporary harm, or potential to cause admission or permanent harm. The drill charts were compared to actual charts by Fischer's Exact Test.


RESULTS
Drill charts contained a significantly greater proportion of errors in regards to performance of procedures, administration of medication, and accuracy of diagnosis. Sixteen percent of these errors were judged as having the potential to cause permanent harm or admission. The exercise charts contained a significantly greater number of omissions in documentation in 9 of the 10 areas evaluated.


CONCLUSIONS
Both the documentation and the quality of care provided during our exercise were deficient when compared with conventional care. Opportunities allowing providers to clearly document pertinent information, and linking of this documentation to relevant prompts and algorithms may minimize this potential for error.
Claudius
Ilene
I
Department of Pediatrics and Division of Emergency Medicine, Childrens Hospital Los Angeles, and Keck School of Medicine, University of Southern California, Los Angeles, Calif 90027, USA.
Behar
Solomon
S
Ballow
Shana
S
Wood
Robin
R
Stevenson
Kathleen
K
Blake
Nancy
N
Upperman
Jeffrey S
JS
D002648:Child; D004189:Disaster Planning / Q000379:methods*; D004282:Documentation / Q000592:standards*; D004635:Emergency Medicine / Q000592:standards; D016529:Emergency Nursing / Q000592:standards; D004636:Emergency Service, Hospital; D006776:Hospitals, Pediatric; D006801:Humans; D015141:Los Angeles; D019300:Medical Errors / Q000517:prevention & control; D016544:Patient Simulation; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care / Q000592:standards*; D012189:Retrospective Studies