Color-Coded Prefilled Medication Syringes Decrease Time to Delivery and Dosing Error in Simulated Emergency Department Pediatric Resuscitations

Abstract

Study objective: The Institute of Medicine has called on the US health care system to identify and reduce medical errors. Unfortunately, medication dosing errors remain commonplace and may result in potentially life-threatening outcomes, particularly for pediatric patients when dosing requires weight-based calculations. Novel medication delivery systems that may reduce dosing errors resonate with national health care priorities. Our goal was to evaluate novel, prefilled medication syringes labeled with color-coded volumes corresponding to the weight-based dosing of the Broselow Tape, compared with conventional medication administration, in simulated pediatric emergency department (ED) resuscitation scenarios.

Methods: We performed a prospective, block-randomized, crossover study in which 10 emergency physician and nurse teams managed 2 simulated pediatric arrest scenarios in situ, using either prefilled, color-coded syringes (intervention) or conventional drug administration methods (control). The ED resuscitation room and the intravenous medication port were video recorded during the simulations. Data were extracted from video review by blinded, independent reviewers.

Results: Median time to delivery of all doses for the conventional and color-coded delivery groups was 47 seconds (95% confidence interval [CI] 40 to 53 seconds) and 19 seconds (95% CI 18 to 20 seconds), respectively (difference=27 seconds; 95% CI 21 to 33 seconds). With the conventional method, 118 doses were administered, with 20 critical dosing errors (17%); with the color-coded method, 123 doses were administered, with 0 critical dosing errors (difference=17%; 95% CI 4% to 30%).

Conclusion: A novel color-coded, prefilled syringe decreased time to medication administration and significantly reduced critical dosing errors by emergency physician and nurse teams during simulated pediatric ED resuscitations.

Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1

Color-coded, prefilled syringes.

Figure 2

Medication doses administered, stratified by study arm and outcomes.

Figure 3

Time to preparation of rapid sequence intubation (RSI) medications, standard syringes versus color-coded syringes.

Figure 4

A, Dosing errors by team, using conventional syringes (N=118 total doses). B, Dosing errors by team, using color-coded, prefilled syringes (N=123 total doses).

Figure 5

A, Percentage error of incorrect doses (N=31) by team, using the conventional syringe method. The horizontal shaded area represents correct dose range. B, Percentage error of incorrect doses (N=5) by team, using the color-coded syringe method. The horizontal shaded area represents correct dose range.