This team worked tightly together and the app development was mainly based on CPR observations and focus groups. The development of PedAMINES followed a user-centered approach with emergency department (ED) caregivers, as well as software developers and ergonomists. Evidence-based development of tools is an efficient way to develop apps that support clinicians. The PedAMINES app lists all the available resuscitation drugs, with doses automatically adapted to the weight or age of the patient. The study was conducted in a PED of a tertiary hospital with approximately 28,000 visits per year. Results of the study were disseminated to the participants after the completion of the study. No participants were asked to advice on interpretation or writing up of results. A senior specialized nurse in pediatric emergency medicine, simulation, and teaching, being an investigator of the study, has participated in the app and study design. Study participants were neither involved in the design of the app, nor in the study design, choice of outcome measures, or the study conduct. Written informed consent was obtained from all the participants before their voluntary involvement. Shift-working nurses were randomly recruited on the day of the study by a blinded, noninvestigator, person on a random list. Selection of ParticipantsĬertified pediatric emergency nurses were eligible if they were actively practicing in our PED. Study design: A two-period, randomized controlled, two-arm crossover study. No changes were made on the app or on the intervention during the study. The study was a prospective, randomized controlled crossover trial with 2 parallel groups ( Figure 1) comparing PedAMINES with a conventional and internationally used drugs infusion rate table method (Frank Shann conventional drug infusion rate table Multimedia Appendix 1) in the preparation of continuous drug infusion, during a standardized simulation-based pediatric postcardiac arrest scenario. We hypothesized that PedAMINES would first reduce the TDP and TDD, and second, reduce medication errors during pediatric CPRs when compared with conventional preparation methods. The development of the app was followed by a study aiming to assess its impact on the error rate and time needed from drug prescription to administration. This app was designed to support nurses and physicians step-by-step from order to delivery of a wide range of drugs in real time, including those requiring continuous infusion. To address these problems, we followed a cognitive and evidence-based ergonomic driven approach to develop an innovative and customizable tablet app, called Pediatric Accurate Medication in Emergency Situations (PedAMINES). Proper preparation and delivery of these drugs could favorably affect the pediatric CPR outcomes. Medication errors have been reported in up to 41% of pediatric resuscitations, the most common being incorrect medication dosage found in up to 65% of cases. The need for individual specific weight-based drug dose calculation and preparation and a lower dosing-error tolerance place children at higher risk than adults for errors and may result in life-threatening outcomes. Quickly, accurately, and safely preparing and administering drugs in a stressful environment is complex and time-consuming. During some critical situations such as postcardiac arrest ROSC or septic shock, preparing intravenous (IV) vasoactive drugs for continuous infusion is particularly challenging. Prolonged resuscitation time may result from TDP. In a study with adults in cardiac arrest, the chance of return of spontaneous circulation (ROSC) was decreased by 4% for every 1-min delay in delivery of vasopressor. During the first 15 min, survival and favorable neurological outcome decrease linearly by 2.1% and 1.2% per minute, respectively, and are negatively affected by drug preparation (TDP) and delivery time (TDD). In CPR, time is a decisive success criterion. In our institution in 2014, cardiopulmonary resuscitation (CPR) accounted for 0.5% of almost 28,000 pediatric visits (0-15 years old). Among them, 6700 to 15,000 cases are due to out-of-hospital cardiac arrest (OHCA), including 6000 related to nontraumatic origins, and 5800 to 10,000 to in-hospital cardiac arrest (INHCA). Immediate (level 1) triage represents 175,000 patient visits every year in US pediatric emergency departments (PED).
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