title: Color-Coded Prefilled Medication Syringes Decrease Time to Delivery and Dosing Error in Simulated Emergency Department Pediatric Resuscitations.
abstract: OBJECTIVE
  The Institute of Medicine has called on the US health care system to identify and reduce medical errors. Unfortunately, medication dosing errors remain commonplace and may result in potentially life-threatening outcomes, particularly for pediatric patients when dosing requires weight-based calculations. Novel medication delivery systems that may reduce dosing errors resonate with national health care priorities. Our goal was to evaluate novel, prefilled medication syringes labeled with color-coded volumes corresponding to the weight-based dosing of the Broselow Tape, compared with conventional medication administration, in simulated pediatric emergency department (ED) resuscitation scenarios.
  
  
  METHODS
  We performed a prospective, block-randomized, crossover study in which 10 emergency physician and nurse teams managed 2 simulated pediatric arrest scenarios in situ, using either prefilled, color-coded syringes (intervention) or conventional drug administration methods (control). The ED resuscitation room and the intravenous medication port were video recorded during the simulations. Data were extracted from video review by blinded, independent reviewers.
  
  
  RESULTS
  Median time to delivery of all doses for the conventional and color-coded delivery groups was 47 seconds (95% confidence interval [CI] 40 to 53 seconds) and 19 seconds (95% CI 18 to 20 seconds), respectively (difference=27 seconds; 95% CI 21 to 33 seconds). With the conventional method, 118 doses were administered, with 20 critical dosing errors (17%); with the color-coded method, 123 doses were administered, with 0 critical dosing errors (difference=17%; 95% CI 4% to 30%).
  
  
  CONCLUSIONS
  A novel color-coded, prefilled syringe decreased time to medication administration and significantly reduced critical dosing errors by emergency physician and nurse teams during simulated pediatric ED resuscitations.
authors.affiliation: Department of Emergency Medicine, Denver Health Medical Center, Denver, CO; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Maria E
authors.initials: ME
authors.lastname: Moreira
authors.affiliation: Department of Emergency Medicine, University of Northern Colorado Medical Center, Greeley, CO.
authors.forename: Caleb
authors.initials: C
authors.lastname: Hernandez
authors.affiliation: Department of Medicine, National Jewish Health, Denver, CO; Division of Emergency Medical Services, Platte Valley Medical Center, Brighton, CO.
authors.forename: Allen D
authors.initials: AD
authors.lastname: Stevens
authors.affiliation: Paramedic Division, Department of Emergency Medicine, Denver Health Medical Center, Denver, CO.
authors.forename: Seth
authors.initials: S
authors.lastname: Jones
authors.affiliation: Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Margaret
authors.initials: M
authors.lastname: Sande
authors.affiliation: Paramedic Division, Department of Emergency Medicine, Denver Health Medical Center, Denver, CO.
authors.forename: Jason R
authors.initials: JR
authors.lastname: Blumen
authors.affiliation: Department of Emergency Medicine, Denver Health Medical Center, Denver, CO; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Emily
authors.initials: E
authors.lastname: Hopkins
authors.affiliation: Department of Emergency Medicine, Denver Health Medical Center, Denver, CO; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Katherine
authors.initials: K
authors.lastname: Bakes
authors.affiliation: Department of Emergency Medicine, Denver Health Medical Center, Denver, CO; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO; Department of Epidemiology, Colorado School of Public Health, Aurora, CO. Electronic address: jason.haukoos@dhha.org.
authors.forename: Jason S
authors.initials: JS
authors.lastname: Haukoos
mesh_terms: D061605:Administration, Intravenous / Q000295:instrumentation / Q000379:methods / Q000592:standards; D002648:Child; D003116:Color; D018592:Cross-Over Studies; D004348:Drug Labeling / Q000379:methods*; D004636:Emergency Service, Hospital; D006801:Humans; D008508:Medication Errors / Q000517:prevention & control*; D012151:Resuscitation / Q000379:methods* / Q000592:standards; D013594:Syringes; D013997:Time Factors