title: Medication dosing errors in pediatric patients treated by emergency medical services.
abstract: BACKGROUND
  Medication dosing errors occur in up to 17.8% of hospitalized children. There are limited data to describe pediatric medication errors by emergency medical services (EMS) paramedics. It has been shown that paramedics have infrequent encounters with pediatric patients.
  
  
  OBJECTIVE
  To characterize medication dosing errors in children treated by EMS.
  
  
  METHODS
  We studied patients aged ≤11 years who were treated by paramedics from eight Michigan EMS agencies from January 2004 through March 2006. We defined a medication dosing error as ≥20% deviation from the weight-appropriate dose, as determined by the patient's reported weight in the prehospital medical record or by use of the Broselow-Luten tape (BLT). We studied errors in administering six EMS medications commonly given to children: albuterol, atropine, dextrose, diphenhydramine, epinephrine, and naloxone.
  
  
  RESULTS
  There were 5,547 children aged ≤11 years who were treated during the study period, of whom 230 (4.1%) received drugs and had a documented weight. These patients received a total of 360 medication administrations. Multiple drug administrations occurred in 73 cases. Medication dosing errors occurred in 125 of the 360 drug administrations (34.7%; 95% confidence interval [CI] 30.0, 39.8). Relative drug dosage errors (with 95% CI) were as follows: albuterol 23.3% (18.4, 29.1), atropine 48.8% (34.3, 63.5), diphenhydramine 53.8% (29.1, 76.8), and epinephrine 60.9% (49.9, 73.9). The mean error (± standard deviation) for intravenous/intraosseous 1:1000 epinephrine overdoses was 808% ± 428%. The mean error (± standard deviation) for intravenous/intraosseous 1:1000 epinephrine underdoses was 35.5% ± 27.4%.
  
  
  CONCLUSIONS
  Medications delivered in the prehospital care of children were frequently administered outside of the proper dose range when compared with patient weights recorded in the prehospital medical record. EMS systems should develop strategies to reduce pediatric medication dosing errors.
authors: Emergency Department, Helen DeVos Children's Hospital/Michigan State University College of Human Medicine, Grand Rapids, Michigan 49503, USA. jdhoyle@hotmail.com
authors: John D
authors: JD
authors: Hoyle
authors: Alan T
authors: AT
authors: Davis
authors: Kevin K
authors: KK
authors: Putman
authors: Jeff A
authors: JA
authors: Trytko
authors: William D
authors: WD
authors: Fales
mesh_terms: D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008508:Medication Errors / Q000706:statistics & numerical data*; D008824:Michigan; D018802:Patient-Centered Care / Q000706:statistics & numerical data*; D010372:Pediatrics / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012449:Safety / Q000706:statistics & numerical data*; D017751:Safety Management