title: Decreasing Prescribing Errors During Pediatric Emergencies: A Randomized Simulation Trial.
abstract: OBJECTIVE
  To evaluate whether a clinical aid providing precalculated medication doses decreases prescribing errors among residents during pediatric simulated cardiopulmonary arrest and anaphylaxis.
  
  
  METHODS
  A crossover randomized trial was conducted in a tertiary care hospital simulation center with residents rotating in the pediatric emergency department. The intervention was a reference book providing weight-based precalculated doses. The control group used a card providing milligram-per-kilogram doses. The primary outcome was the presence of a prescribing error, defined as a dose varying by ≥20% from the recommended dose or by incorrect route. Residents were involved in 2 sets of paired scenarios and were their own control group. Primary analysis was the difference in mean prescribing error proportions between both groups.
  
  
  RESULTS
  Forty residents prescribed 1507 medications or defibrillations during 160 scenarios. The numbers of prescribing errors per 100 bolus medications or defibrillations were 5.1 (39 out of 762) and 7.5 (56 out of 745) for the intervention and control, respectively, a difference of 2.4 (95% confidence interval [CI], -0.1 to 5.0). However, the intervention was highly associated with lower risk of 10-fold error for bolus medications (odds ratio 0.27; 95% CI, 0.10 to 0.70). For medications administered by infusion, prescribing errors occurred in 3 out of 76 (4%) scenarios in the intervention group and 13 out of 76 (22.4%) in the control group, a difference of 13% (95% CI, 3 to 23).
  
  
  CONCLUSIONS
  A clinical aid providing precalculated medication doses was not associated with a decrease in overall prescribing error rates but was highly associated with a lower risk of 10-fold error for bolus medications and for medications administered by continuous infusion.
authors.affiliation: Division of Emergency Medicine, Department of Pediatrics and guylainelarose@gmail.com.
authors.forename: Guylaine
authors.initials: G
authors.lastname: Larose
authors.affiliation: Division of Emergency Medicine, Department of Pediatrics and.
authors.forename: Arielle
authors.initials: A
authors.lastname: Levy
authors.affiliation: Division of Emergency Medicine, Department of Pediatrics and.
authors.forename: Benoit
authors.initials: B
authors.lastname: Bailey
authors.affiliation: Division of Emergency Medicine, Department of Pediatrics and.
authors.forename: Barbara
authors.initials: B
authors.lastname: Cummins-McManus
authors.affiliation: Department of Pharmacy, CHU Sainte-Justine, Université de Montreal, Montreal, Quebec, Canada.
authors.forename: Denis
authors.initials: D
authors.lastname: Lebel
authors.affiliation: Division of Emergency Medicine, Department of Pediatrics and.
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Gravel
mesh_terms: D000328:Adult; D000707:Anaphylaxis / Q000188:drug therapy; D018592:Cross-Over Studies; D054796:Drug Dosage Calculations; D004554:Electric Countershock; D004635:Emergency Medicine / Q000193:education; D004636:Emergency Service, Hospital; D005260:Female; D005572:Formularies, Hospital as Topic; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008348:Manikins; D008508:Medication Errors / Q000517:prevention & control* / Q000706:statistics & numerical data; D010372:Pediatrics / Q000193:education; D011792:Quebec; D000066908:Simulation Training; D017180:Tachycardia, Ventricular / Q000628:therapy; D014693:Ventricular Fibrillation / Q000628:therapy; D055815:Young Adult