Effect of an intervention standardization system on pediatric dosing and equipment size determination - A crossover trial involving simulated resuscitation events

Background: Pediatric medication dosing has been recognized as a high-error activity with the potential to cause serious harm. Few studies assess systems approaches to error reduction in pediatrics. Objective: To estimate the decrease in deviation from recommended medication doses associated with use of a pediatric intervention standardization system in the acute setting. Design: Two-period, 2-treatment crossover trial with data collected between December 1, 1999, and February 29, 2000. Setting: Tertiary, academic medical center. Participants: Convenience sample of 28 resident physicians, representing 69% of pediatrics and 50% of medicine-pediatrics residents. Intervention: Each resident participated in 4 simulated pediatric resuscitations. The Broselow Pediatric Emergency Tape and color-coded materials were available in either the first or second 2 scenarios. Traditional dosing references were available in all scenarios. Main Outcome Measure: Median difference between deviation from recommended dose range (DRDR) in scenarios where color coding was used (intervention) and DRDR in scenarios where color coding was not available(control). Results: Median DRDR in intervention scenarios was 25.4% lower than in control scenarios (95% confidence interval '[CI],19.1%-32.5%; P<001). In 4 medication prescriptions in intervention scenarios and in 54 prescriptions in control scenarios, DRDRs exceeded 100%. Median deviation from recommended equipment sizes in intervention scenarios was 0.12 size lower than in control scenarios (95% CI, 0.03-0.22 size; P<001). Deviations in equipment size of 2 or more sizes were noted in 1 size determination in intervention scenarios and in 21 size determinations in control scenarios. Conclusions: Color coding was associated with a significant reduction in deviation from recommended doses in simulated pediatric emergencies. Numerous potentially clinically significant deviations from recommended doses and equipment sizes were avoided. Future studies should measure impact in the real clinical setting.