qMedication errors are a well-defined cause of preventable adverse events in pediatrics

qDespite correct calculations of dosages, errors continue to occur during preparation and administration

qEmergency situations have a tenfold increase in errors

qEpinephrine and atropine have a very high potential for harm in patients less than 10 kg

qWeight-based miscalculationqAdult formulationq Lack of pharmacology trainingqMedications administered in chaotic

environmentqTransitions of care

Found provider’s using a patient-specific drug sheet during

simulated pediatric emergencies obtained

the correct dose 3X faster and were 21.4% more

accurate compared to paper-based methods

q In a children’s hospital, will education on the use of a pediatric emergency drug sheet increase PACU and endoscopy RN’s clinical preparedness and self-efficacy during a pediatric resuscitation?

Utilizing a Pediatric Emergency Drug Sheet to Enhance Clinical Preparedness and Self-Efficacy in Medication Administration

Martha Renteria BSN, RN, RRNA Project Chair: Maureen Mccartney Anderson, DNP, CRNA, APNArianna Sinkovich BSN, RN, RRNA Team Member: Michael McLaughlin, DNP, CRNA, APN

qFamiliarize RNs to drug sheet outside of an emergency

qCreate anon-punitive environment where staff can practice skills withoutcompromising patient safety

qSelf-evaluate their practice for potential knowledge gaps in drug preparation

qProspective Cohort StudyqSetting

- Large University Hospital- Pediatric Hospital Designation- Fall pediatric competency

qPopulation- PACU and Endoscopy RNs- Range of ages and experience- Sample size 32

qLow riskqNo economical benefits

Pre-Intervention Survey qEvaluate current use of pediatric drug sheet

and level of confidence in preparing and administering Epinephrine and atropine in patients less than 10 kg

Interventionq PowerPoint presentation

regarding basic epinephrineand atropine pharmacology

qReview location of sheetqWork in groups to solve a

case scenario in which apatient less than 10 kg requires epinephrine or atropine administration by using the pediatric drug sheet

qReturn demonstration of dose in mL and mgqMock syringes suppliedPost Intervention Surveyq 1-month Post-intervention Survey

q There are response percentages for questions 1-7. The higher the score the greater the self-efficacy, four being the highest score

q In the presurvey, the percentage for a score of 4,was always less than 50% of the participants, a score of four was greater than 50% in the post survey for all questions

q Below are response percentages for questions 8-10

q These questions correspond to the aim of a change in behavioral intention after an educational session

qStatistical analysis was conducted via SPSS. Descriptive statistics and an exact sign test were performed on pre- and post-data

qThe exact sign data for questions 1-7 demonstrate a statically significant difference in median scores of the Likert scale in pre- and post-survey at a significance level of 0.05

qThis statically significant change shows an increase in clinical self-efficacy for RNs after the intervention

qThere was no statistically significant difference in median scores for a change in behavioral intention

BACKGROUND

SOURCES OF ERRORS

JOINT COMMISSION RECOMMENDATION

PROBLEM STATEMENT

OBJECTIVES

METHODOLOGY

Pediatric Weight-Based Emergency ReferenceWeight: 8 kg

Epinephrine (1: 10,000)(0.1 mg/mL)

IV, IO 0.01 mg/kg

0.08 mg 0.8 mL

Max single dose = 1mg; Repeat q 3-5 min

Atropine (0.1 mg/mL)

IV, IO 0.02 mg/kg

0.16 mg 1.6 mL

May repeat once in 3-5 min; max cumulative dose = 1mg

RESULTS

PROJECT DESIGN

REFERENCES

qScan QR code below to view references and more information

q 100% of RNs were able to display clinical preparedness by appropriately using the pediatric drug sheet to prepare and “administer” correct doses of epinephrine and atropine, in mgs and mLs, for a pediatric patient weighing less than 10kg

qAlthough the RNs were already inclined to use the drug sheet, their self-efficacy in preparing and administering medications via the drug sheet was higher post implementation

qFuture studies can ensure sustainability by conducting a 3-month post implementation survey to show the impact over a prolonged period of time.

qOur results highlighthow crucial it is for healthcare institutionsto provide cognitive aids and establish policies that promotepatient safety by supporting nursing staff to translate knowledge into practice

0%

3%

9%

22%

66%

3%

3%

34%

3%

56%

STRONGLY DISAGREE

DISAGREE

NEUTRAL

EASY

STRONGLY AGREE

Q8 Pre and Post Results

Q8 Pre Q8 Post

RESULTS

DISCUSSION

Pediatric medication errors are 3X higher

than adults

Pre-printed Emergency Dosage Calculation Sheet

Practice without compromising patient

safety

Sustainability via Mandatory Annual

Pediatric Competency Day

13%

6%

9%

0%

9%

0%

16%

0%

19%

3%

38%

3%

38%

3%

31%

9%

34%

9%

34%

9%

28%

9%

34%

6%

31%

6%

31%

13%

34%

25%

31%

16%

34%

9%

25%

19%

34%

31%

19%

25%

19%

25%

22%

59%

25%

75%

22%

81%

31%

72%

13%

59%

13%

66%

13%

59%

Q1 PRE Q1 POST Q2 PRE Q2 POST Q3PRE Q3 POST Q4 PRE Q4 POST Q5 PRE Q5 POST Q6 PRE Q6 POST Q7 PRE Q7 POST

Questions 1-7 Pre and Post Results

Not true at all Somewhat Not True Somewhat True Exactly True