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Drug preparation and administration errors during simulated paediatric resuscitations
  1. Sashen Murugan,
  2. Pano Parris,
  3. Mike Wells
  1. Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
  1. Correspondence to Dr Mike Wells, Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2190, South Africa; mike.wells{at}emergencymedicine.co.za

Abstract

Introduction Very few studies have assessed drug preparation and administration errors during paediatric resuscitation. Current evidence suggests that medication errors in paediatrics are a serious problem. The aim of this study was to evaluate drug preparation and administration errors incurred during the simulated resuscitation of paediatric patients.

Methods This was a prospective observational study performed in the emergency department of a tertiary-level hospital. Teams consisting of two emergency doctors were tasked with preparing and delivering medication during simulated emergency scenarios. Preparation processes were video recorded. All phials, syringes and administered volumes were collected and analysed to determine the accuracy of drug preparation and delivery. Deviations from intended volumes were calculated.

Main results A total of 96 dosages were recorded from 24 participants. Most errors were identified in the withdrawal of drug phase (prior to dilution) (13 of 96 doses had a >20% error), and the administration of medication phase (20 of 96 doses had a >20% error). Overall the median time taken to deliver each drug was 79 s (IQR 59, 100 s). The largest percentage errors were seen when a large syringe was used to withdraw or administer a small volume of medication.

Conclusion The study clearly demonstrated that there were significant errors in the preparation and administration of medication. Training in the preparation and administration of paediatric medications should be available for all emergency nurses and doctors. Correct syringe choice may reduce these errors—smaller syringes should be used for withdrawing or administering smaller volumes.

  • resuscitation
  • clinical procedures
  • general paediatrics

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Footnotes

  • Contributors SM: project design, data collection, data analysis, drafting of manuscript. PP: project design, data collection, revision of manuscript. MW: project design, data collection, data analysis, drafting and revision of manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval This study was approved by the University of the Witwatersrand Human Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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