Computerized pharmaceutical algorithm reduces medication administration errors during simulated resuscitations

Abstract

Objective: Medication errors involving intravenous medications continue to be a significant problem, particularly in the pediatric population due to the high rate of point-of-care and weight-adjusted dosing. The pharmaceutical algorithm computerized calculator (pac2) assists in converting physician medication orders to correct volumes and rates of administration for intravenous medications. This study was designed to assess the efficacy of the pac2 in simulated clinical scenarios of point-of-care dosing.

Methods: The study design was a within-subject controlled study in which 33 nurses from pediatrics, pediatric critical care, or critical care (mean nursing experience of 10.9 years) carried out various point-of-care medication-dosing scenarios with and without the aid of the pac2.

Results: Use of the pac2 resulted in a significantly higher percentage (mean [95% CI]) of medication volumes calculated and drawn accurately (91% [87-95%] versus 61% [52-70%], p<0.0001), a higher percentage of correct recall of essential medication information (97% [95-99%] versus 45% [36-53%], p<0.0001), and better recognition of unsafe doses (93% [87-99%] versus 19% [12-27%], p<0.0001) as compared to usual practice. The pac2 also significantly reduced average medication calculation times (1.5 minutes [1.3-1.7 minutes] versus 1.9 minutes [1.6-2.2 minutes], p=0.0028) as compared to usual practice.

Conclusions: The pac2 significantly improved the performance of drug calculations by pediatric and critical care nurses during simulated clinical scenarios designed to mimic point-of-care dosing. These results suggest that the pac2 addresses an area of safety vulnerability for point-of-care dosing practices and could be a useful addition to a hospital's overall program to minimize medication errors.

Figure 1

Typical Process and Individual Responsibilities for Point-of-Care Medication Dosing of Hospitalized Patients

Figure 2

. Screen of the Pharmaceutical Algorithm Computerized Calculator.

Figure 3

Comparison of Outcome Variables for Simulated Scenario Sets with and without the Pharmaceutical Algorithm Computerized Calculator. Without PAC2, ▪ With PAC2, Percent correct response with 95% confidence intervals, ^* = Significance of paired difference, p<0.0001

Figure 4

Average Drug Calculation Times (minutes) with and without the Pharmaceutical Algorithm Computerized Calculator. Without PAC2, ▪ With PAC2, Average drug calculation time (minutes) with 95% confidence intervals, * = Significance of paired difference