title: Color-coded prefilled medication syringes decrease time to delivery and dosing errors in simulated prehospital pediatric resuscitations: A randomized crossover trial.
abstract: BACKGROUND
  Medication dosing errors remain commonplace and may result in potentially life-threatening outcomes, particularly for pediatric patients where dosing often requires weight-based calculations. Novel medication delivery systems that may reduce dosing errors resonate with national healthcare 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 to conventional medication administration, in simulated prehospital pediatric resuscitation scenarios.
  
  
  METHODS
  We performed a prospective, block-randomized, cross-over study, where 10 full-time paramedics each managed two simulated pediatric arrests in situ using either prefilled, color-coded syringes (intervention) or their own medication kits stocked with conventional ampoules (control). Each paramedic was paired with two emergency medical technicians to provide ventilations and compressions as directed. The ambulance patient compartment and the intravenous medication port were video recorded. Data were extracted from video review by blinded, independent reviewers.
  
  
  RESULTS
  Median time to delivery of all doses for the intervention and control groups was 34 (95% CI: 28-39) seconds and 42 (95% CI: 36-51) seconds, respectively (difference=9 [95% CI: 4-14] seconds). Using the conventional method, 62 doses were administered with 24 (39%) critical dosing errors; using the prefilled, color-coded syringe method, 59 doses were administered with 0 (0%) critical dosing errors (difference=39%, 95% CI: 13-61%).
  
  
  CONCLUSIONS
  A novel color-coded, prefilled syringe decreased time to medication administration and significantly reduced critical dosing errors by paramedics during simulated prehospital pediatric resuscitations.
authors.affiliation: Department of Medicine, National Jewish Health, Denver, CO, USA; Division of Emergency Medical Services, Platte Valley Medical Center, Brighton, CO, USA.
authors.forename: Allen D
authors.initials: AD
authors.lastname: Stevens
authors.affiliation: Department of Emergency Medicine, University of Northern Colorado Medical Center, Greeley, CO, USA.
authors.forename: Caleb
authors.initials: C
authors.lastname: Hernandez
authors.affiliation: Paramedic Division, Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, USA.
authors.forename: Seth
authors.initials: S
authors.lastname: Jones
authors.affiliation: Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, USA; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Maria E
authors.initials: ME
authors.lastname: Moreira
authors.affiliation: Paramedic Division, Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, USA.
authors.forename: Jason R
authors.initials: JR
authors.lastname: Blumen
authors.affiliation: Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, USA; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Hopkins
authors.affiliation: Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Margaret
authors.initials: M
authors.lastname: Sande
authors.affiliation: Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, USA; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Katherine
authors.initials: K
authors.lastname: Bakes
authors.affiliation: Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, USA; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA; Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA. Electronic address: Jason.Haukoos@dhha.org.
authors.forename: Jason S
authors.initials: JS
authors.lastname: Haukoos
mesh_terms: D061605:Administration, Intravenous / Q000295:instrumentation; D000293:Adolescent; D000328:Adult; D002648:Child; D003116:Color; D018592:Cross-Over Studies; D004348:Drug Labeling / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D008297:Male; D008508:Medication Errors / Q000517:prevention & control* / Q000639:trends; D016544:Patient Simulation; D011446:Prospective Studies; D012151:Resuscitation / Q000379:methods* / Q000592:standards; D013594:Syringes / Q000592:standards*; D013997:Time Factors
keywords: Cardiac arrest; Dosing error; Emergency medical services; Medication administration; Pediatrics; Simulation