A Mobile Device App to Reduce Time to Drug Delivery and Medication Errors During Simulated Pediatric Cardiopulmonary Resuscitation: A Randomized Controlled Trial.
During pediatric cardiopulmonary resuscitation (CPR), vasoactive drug preparation for continuous infusion is both complex and time-consuming, placing children at higher risk than adults for medication errors. Following an evidence-based ergonomic-driven approach, we developed a mobile device app called Pediatric Accurate Medication in Emergency Situations (PedAMINES), intended to guide caregivers step-by-step from preparation to delivery of drugs requiring continuous infusion.



The aim of our study was to determine whether the use of PedAMINES reduces drug preparation time (TDP) and time to delivery (TDD; primary outcome), as well as medication errors (secondary outcomes) when compared with conventional preparation methods.



The study was a randomized controlled crossover trial with 2 parallel groups comparing PedAMINES with a conventional and internationally used drugs infusion rate table in the preparation of continuous drug infusion. We used a simulation-based pediatric CPR cardiac arrest scenario with a high-fidelity manikin in the shock room of a tertiary care pediatric emergency department. After epinephrine-induced return of spontaneous circulation, pediatric emergency nurses were first asked to prepare a continuous infusion of dopamine, using either PedAMINES (intervention group) or the infusion table (control group), and second, a continuous infusion of norepinephrine by crossing the procedure. The primary outcome was the elapsed time in seconds, in each allocation group, from the oral prescription by the physician to TDD by the nurse. TDD included TDP. The secondary outcome was the medication dosage error rate during the sequence from drug preparation to drug injection.



A total of 20 nurses were randomized into 2 groups. During the first study period, mean TDP while using PedAMINES and conventional preparation methods was 128.1 s (95% CI 102-154) and 308.1 s (95% CI 216-400), respectively (180 s reduction, P=.002). Mean TDD was 214 s (95% CI 171-256) and 391 s (95% CI 298-483), respectively (177.3 s reduction, P=.002). Medication errors were reduced from 70% to 0% (P<.001) by using PedAMINES when compared with conventional methods.



In this simulation-based study, PedAMINES dramatically reduced TDP, to delivery and the rate of medication errors.
Department of Pediatric Emergency Medicine, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland.
Johan N
0000-0002-2871-3382
JN
Siebert
Department of Radiology and Medical Informatics, Division of Medical Information Sciences, University Hospitals of Geneva, Geneva, Switzerland.
Frederic
0000-0001-9734-3242
F
Ehrler
Department of Health and Community Medicine, Division of Clinical Epidemiology, University of Geneva and University Hospitals of Geneva, Geneva, Switzerland.
Christophe
0000-0003-2631-4780
C
Combescure
Department of Pediatric Emergency Medicine, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland.
Laurence
0000-0002-6636-3344
L
Lacroix
Department of Pediatric Emergency Medicine, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland.
Kevin
0000-0002-3223-1810
K
Haddad
Department of Pediatric Surgery, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland.
Oliver
0000-0003-0008-7436
O
Sanchez
Department of Pediatric Emergency Medicine, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland.
Alain
0000-0002-8925-5936
A
Gervaix
Department of Radiology and Medical Informatics, Division of Medical Information Sciences, University Hospitals of Geneva, Geneva, Switzerland.
Christian
0000-0002-2681-8076
C
Lovis
Department of Pediatric Emergency Medicine, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland.
Sergio
0000-0001-9603-5520
S
Manzano
D000328:Adult; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D018592:Cross-Over Studies; D016503:Drug Delivery Systems / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008348:Manikins; D008508:Medication Errors / Q000517:prevention & control; D063731:Mobile Applications; D010372:Pediatrics / Q000379:methods; D011446:Prospective Studies
biomedical technology; medication errors; pediatrics; pharmaceutical preparations; resuscitation