TY - JOUR
T1 - The Effect of Documenting Patient Weight in Kilograms on Pediatric Medication Dosing Errors in Emergency Medical Services
AU - Ward, Caleb E.
AU - Taylor, Michael
AU - Keeney, Clare
AU - Dorosz, Emily
AU - Wright-Johnson, Cynthia
AU - Anders, Jennifer
AU - Brown, Kathleen
N1 - Funding Information:
The EMS Compass project was launched in 2014 to develop performance measures that would help improve the quality of EMS care at the local, state & national levels (). This project was funded by the National Highway Traffic Safety Administration (NHTSA) Office of EMS and led by the National Association of State EMS Officials (NASEMSO). PEDS-03 was one of only three pediatric-specific performance measures adopted as part of this project. This performance measure tracked the proportion of patients < 15 years of age that received a medication for which a weight was recorded in kilograms. The National EMS Quality Alliance (NEMSQA) has adopted a similar performance measure (Pediatrics-03b). The stated rationale for this measure was that medication errors are common in pediatric patients and are often based on an incorrect weight. However, there is little direct evidence from the prehospital setting that requiring weight to be documented in kilograms is associated with a lower rate of medication dosing errors. The recent National Association of EMS Physicians (NAEMSP) position statement on pediatric dosing errors noted a lack of EMS research in this area (). Our objective, therefore, was to use statewide EMS data to analyze whether children with a weight documented in kilograms have lower rates of medication dosing errors than those without a weight documented in kilograms.
Publisher Copyright:
© 2022 National Association of EMS Physicians.
PY - 2023
Y1 - 2023
N2 - Objectives: Up to 40% of children who receive a medication from emergency medical services (EMS) are subject to a dosing error. One of the reasons for this is difficulties adjusting dosages for weight. Converting weights from pounds to kilograms complicates this further. This is the rationale for the National EMS Quality Alliance measure Pediatrics-03b, which measures the proportion of children with a weight documented in kilograms. However, there is little evidence that this practice is associated with lower rates of dosing errors. Therefore, our objective was to determine whether EMS documentation of weight in kilograms was associated with a lower rate of pediatric medication dosing errors. Methods: We conducted a retrospective cross-sectional study of children 0-14 y/o in the 2016-17 electronic Maryland Emergency Medical Services Data System that received a weight-based medication. Using validated age-based formulas, we assigned a weight to patients without one documented. Doses were classified as errors and severe errors if they deviated from the state protocol by >20% or >50%, respectively. We compared the dosage errors in the two groups and completed secondary analyses for specific medications and age groups. Results: We identified 3,618 cases of medication administration, 53% of which had a documented weight. Patients with a documented weight had a significantly lower overall dose error rate than those without (22 vs. 26%, p<.05). A sensitivity analysis in which we assigned a weight to those patients with a weight recorded did not significantly change this result. Sub-analyses by individual medication showed that only epinephrine (34 vs. 56%, p<.05) and fentanyl (10 vs. 31%, p <.05) had significantly lower dosing error rates for patients with a documented weight. Infants were the only age group where documenting a weight was associated with a lower dosing error rate (33 vs. 53% p<.05). Conclusion: Our findings suggest that documenting a weight in kilograms is associated with a small but significantly lower rate of pediatric dosing errors by EMS. Documenting a weight in kilograms appears particularly important for specific medications and patient age groups. Additional strategies (including age-based standardized dosing) may be needed to further reduce pediatric dosing errors by EMS.
AB - Objectives: Up to 40% of children who receive a medication from emergency medical services (EMS) are subject to a dosing error. One of the reasons for this is difficulties adjusting dosages for weight. Converting weights from pounds to kilograms complicates this further. This is the rationale for the National EMS Quality Alliance measure Pediatrics-03b, which measures the proportion of children with a weight documented in kilograms. However, there is little evidence that this practice is associated with lower rates of dosing errors. Therefore, our objective was to determine whether EMS documentation of weight in kilograms was associated with a lower rate of pediatric medication dosing errors. Methods: We conducted a retrospective cross-sectional study of children 0-14 y/o in the 2016-17 electronic Maryland Emergency Medical Services Data System that received a weight-based medication. Using validated age-based formulas, we assigned a weight to patients without one documented. Doses were classified as errors and severe errors if they deviated from the state protocol by >20% or >50%, respectively. We compared the dosage errors in the two groups and completed secondary analyses for specific medications and age groups. Results: We identified 3,618 cases of medication administration, 53% of which had a documented weight. Patients with a documented weight had a significantly lower overall dose error rate than those without (22 vs. 26%, p<.05). A sensitivity analysis in which we assigned a weight to those patients with a weight recorded did not significantly change this result. Sub-analyses by individual medication showed that only epinephrine (34 vs. 56%, p<.05) and fentanyl (10 vs. 31%, p <.05) had significantly lower dosing error rates for patients with a documented weight. Infants were the only age group where documenting a weight was associated with a lower dosing error rate (33 vs. 53% p<.05). Conclusion: Our findings suggest that documenting a weight in kilograms is associated with a small but significantly lower rate of pediatric dosing errors by EMS. Documenting a weight in kilograms appears particularly important for specific medications and patient age groups. Additional strategies (including age-based standardized dosing) may be needed to further reduce pediatric dosing errors by EMS.
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U2 - 10.1080/10903127.2022.2028045
DO - 10.1080/10903127.2022.2028045
M3 - Article
C2 - 35007470
AN - SCOPUS:85124327896
SN - 1090-3127
VL - 27
SP - 263
EP - 268
JO - Prehospital Emergency Care
JF - Prehospital Emergency Care
IS - 2
ER -