Comparing errors in ED computer-assisted vs conventional pediatric drug dosing and administration

Volume 28, Issue 5, Pages 588-592 (June 2010)

Comparing errors in ED computer-assisted vs conventional pediatric drug dosing and administration

Loren Yamamoto, MD, MPH, Joan Kanemori, RN


Received 25 December 2008; accepted 10 February 2009. published online 23 November 2009.

Abstract
Background
Compared to fixed-dose single-vial drug administration in adults, pediatric drug dosing and administration requires a series of calculations, all of which are potentially error prone. The purpose of this study is to compare error rates and task completion times for common pediatric medication scenarios using computer program assistance vs conventional methods.

Methods
Two versions of a 4-part paper-based test were developed. Each part consisted of a set of medication administration and/or dosing tasks. Emergency department and pediatric intensive care unit nurse volunteers completed these tasks using both methods (sequence assigned to start with a conventional or a computer-assisted approach). Completion times, errors, and the reason for the error were recorded.

Results
Thirty-eight nurses completed the study. Summing the completion of all 4 parts, the mean conventional total time was 1243 seconds vs the mean computer program total time of 879 seconds (P < .001). The conventional manual method had a mean of 1.8 errors vs the computer program with a mean of 0.7 errors (P < .001). Of the 97 total errors, 36 were due to misreading the drug concentration on the label, 34 were due to calculation errors, and 8 were due to misplaced decimals. Of the 36 label interpretation errors, 18 (50%) occurred with digoxin or insulin.

Conclusions
Computerized assistance reduced errors and the time required for drug administration calculations. A pattern of errors emerged, noting that reading/interpreting certain drug labels were more error prone. Optimizing the layout of drug labels could reduce the error rate for error-prone labels.

Kapiolani Medical Center For Women And Children, Honolulu, HI 96826, USA

University of Hawaii John A. Burns School of Medicine, Honolulu, HI 96826, USA

Corresponding author. Honolulu, HI 96828, USA. Tel.: +1 808 983 8387; fax: +1 413 208 2795.

PII: S0735-6757(09)00079-5

doi:10.1016/j.ajem.2009.02.009

© 2010 Elsevier Inc. All rights reserved.

Comparing errors in ED computer-assisted vs conventional pediatric drug dosing and administration