Prevention of pediatric drug calculation errors by prehospital care providers.

OBJECTIVE: Calculating weight-based drug doses for pediatric patients is difficult, with significant error potential. In the prehospital setting, few safeguards currently avert pediatric drug administration errors. We sought to determine whether use of a protocol-specific pediatric code card enables prehospital care providers to calculate more consistently accurate weight-based drug doses, volumes of administration, and age-appropriate endotracheal tube sizes.
METHODS: Questionnaires requiring calculations of medication doses, volumes, and endotracheal tube sizes were administered to prehospital care providers between June and November 2006 in fire department continuing education classes in the State of Maryland and the District of Columbia. Half of the participants performed the calculations with the pediatric code card as an aid, and half without. Calculations done by the two groups were compared for rate and extent of errors. We evaluated the error frequency in calculations of pediatric medication doses and endotracheal tube sizes.
RESULTS: Of the 523 advanced life support prehospital care providers questioned, 246 answered questions using the pediatric code card, and 277 answered questions without using the card. The mean individual percentages of correct responses were 94% for the group aided by the code card and 65% for the group unaided by the card (percentage difference, 29%; 95% confidence interval [CI], 25-31%; p < 0.001). Ninety-eight percent of the aided group and 23% of the unaided group calculated the correct endotracheal tube size (percentage difference, 75%; 95% CI, 70-81%; p < 0.001).
CONCLUSIONS: The use of the pediatric code card enabled prehospital care providers to determine weight-based drug doses, volumes of administration, and endotracheal tube sizes more accurately than peers without access to the code card.