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Validation of a mobile app for reducing errors of administration of medications in an emergency

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Medication errors occur frequently and are a risk to patient safety. To reduce mistakes in the medication process in emergencies, a mobile app has been developed supporting the calculation of doses and administration of drugs. A simulation study was performed to validate the app as a tool to reduce medication errors. This was a randomised crossover study conducted in the Academic Hospital. The participants included were residents and attendings in anaesthesiology. 74 Participants performed four simulation scenarios in which they had to calculate and administer drugs for emergencies. Two scenarios were performed with the app (“app scenarios”) and the other two scenarios were performed without the use of the app (“control scenarios”). The order of drugs, simulation patients and usage of aid were randomized. The accuracy of administered drug doses were measured. Medications were categorised as either “accurate” (\(\pm 20\)% of target dosage) or “wrong” (less than 50% or more than 200% of target dosage). The dosage calculated and the dosage administered were documented separately to differentiate between calculation and handling errors. During app scenarios, there were no “wrong” dosages, whereas 6.8 (95% CI 2.7–10.8%) of dosages in control scenarios were evaluated as “wrong”. The probability of giving an “accurate” dosage was increased from 77.7 (70.9–84.5%) in control scenarios to 93.9 (90–97.8%) in app scenarios. Calculation errors were the main cause for wrong dosing. The app is an appropriate and feasible tool to reduce calculation and handling errors and may increase patient safety.

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  1. Walsh EK, Hansen CR, Sahm LJ, Kearney PM, Doherty E, Bradley CP. Economic impact of medication error: a systematic review. Pharmacoepidemiol Drug Saf. 2017;26(5):481–97.

    Article  PubMed  Google Scholar 

  2. Bates DW, Boyle DL, Vliet Vander MB, Schneider J, Leape L. Relationship between medication errors and adverse drug events. J Gen Intern Med. 1995;10(4):199–205.

    Article  CAS  PubMed  Google Scholar 

  3. Ghaleb MA, Barber N, Franklin BD, Yeung VWS, Khaki ZF, Wong ICK. Systematic review of medication errors in pediatric patients. Ann Pharmacother. 2006;40(10):1766–76.

    Article  PubMed  Google Scholar 

  4. Hixson R, Gandhi M, Holton F. A randomised trial to evaluate prescribing accuracy when using the Paediatric Analgesia Wheel. Arch Dis Child. 2009;94(4):268–72.

    Article  CAS  PubMed  Google Scholar 

  5. Lifshitz AE, Goldstein LH, Sharist M, Strugo R, Asulin E, Haim Bar S, Feigenberg Z, Berkovitch M, Kozer E. Medication prescribing errors in the prehospital setting and in the ED. Am J Emerg Med. 2012;30(5):726–31.

    Article  PubMed  Google Scholar 

  6. Bolt R, Yates JM, Mahon J, Bakri I. Evidence of frequent dosing errors in paediatrics and intervention to reduce such prescribing errors. J Clin Pharm Ther. 2014;39(1):78–83.

    Article  CAS  PubMed  Google Scholar 

  7. Strauss J. New pediatric drug dosage aids. Med Klin Intensivmed Notf med. 2016;111(2):118–23.

    Article  CAS  Google Scholar 

  8. Avidan A, Levin PD, Weissman C, Gozal Y. Anesthesiologists’ ability in calculating weight-based concentrations for pediatric drug infusions: an observational study. J Clin Anesth. 2014;26(4):276–80.

    Article  CAS  PubMed  Google Scholar 

  9. Kohn LT, Corrigan JM, Donaldson MS. To err is human: building a safer health system. Institute of Medicine (US) Committee on Quality of Health Care in America; 2000.

  10. Schnurrer JU, Frölich JC. Zur Häufigkeit und Vermeidbarkeit von tödlichen unerwünschten Arzneimittelwirkungen. Der Internist. 2003;44(7):889–95.

    Article  CAS  PubMed  Google Scholar 

  11. Beaudoin FL, Merchant RC, Janicki A, McKaig DM, Babu KM. Preventing iatrogenic overdose: a review of in-emergency department opioid-related adverse drug events and medication errors. Ann Emerg Med. 2015;65(4):423–31.

    Article  PubMed  Google Scholar 

  12. Kaufmann J, Laschat M, Wappler F. Medication errors in pediatric emergencies: a systematic analysis. Dtsch Ärztebl Int. 2012;109(38):609–16.

    PubMed  PubMed Central  Google Scholar 

  13. Luten R. Error and time delay in pediatric trauma resuscitation: addressing the problem with color-coded resuscitation aids. Surg Clin N Am. 2002;82(2):303–14.

    Article  PubMed  Google Scholar 

  14. Erker CG, Santamaria M, Möllmann M. Hilfsmittel für die Dosierung von Notfallmedikamenten im Kindesalter. Der Anaesth. 2012;61(11):965–70.

    Article  CAS  Google Scholar 

  15. Brinkrolf P, Prien T, Van Aken H. Medikationsfehler- Eine systematische Analyse der Berichte im CIRS-AINS. Anästhesiol Intensivmed. 2013;54:126–32.

    Google Scholar 

  16. Vilke GM, Tornabene SV, Stepanski B, Shipp HE, Ray LU, Metz MA, Vroman D, Anderson M, Murrin PA, Davis DP, Harley J. Paramedic self-reported medication errors. Prehosp Emerg Care. 2007;11(1):80–4.

    Article  PubMed  Google Scholar 

  17. Bernius M, Thibodeau B, Jones A, Clothier B, Witting M. Prevention of pediatric drug calculation errors by prehospital care providers. Prehosp Emerg Care. 2008;12(4):486–94.

    Article  PubMed  Google Scholar 

  18. Shah AN, Frush K, Luo X, Wears RL. Effect of an intervention standardization system on pediatric dosing and equipment size determination: a crossover trial involving simulated resuscitation events. Arch Pediatr Adolesc Med. 2003;157(3):229–36.

    Article  PubMed  Google Scholar 

  19. Larose G, Levy A, Bailey B, Cummins-McManus B, Lebel D, Gravel J. Decreasing prescribing errors during pediatric emergencies: a randomized simulation trial. Pediatrics. (2017).

  20. Heimberg E, Heinzel O, Hoffmann F. Typische Probleme bei Kindernotfällen. Med Klin Intensivmed Notf med. 2015;110(5):354–9.

    Article  CAS  Google Scholar 

  21. Kaji AH, Gausche-Hill M, Conrad H, Young KD, Koenig WJ, Dorsey E, Lewis RJ. Emergency medical services system changes reduce pediatric epinephrine dosing errors in the prehospital setting. Pediatrics. 2006;118(4):1493–500.

    Article  PubMed  Google Scholar 

  22. Ashcroft DM, Lewis PJ, Tully MP, Farragher TM, Taylor D, Wass V, Williams SD, Dornan T. Prevalence, nature, severity and risk factors for prescribing errors in hospital inpatients: prospective study in 20 UK hospitals. Drug Saf. (2015).

  23. Elashwah M. Medication errors in ambulatory paediatric patient setting how close, or far, are we from an error free process? Infect Disord Drug Targets. 2015;14(3):191–204.

    Article  CAS  Google Scholar 

  24. Lammers R, Byrwa M, Fales W. Root causes of errors in a simulated prehospital pediatric emergency. Acad Emerg Med. 2012;19(1):37–47.

    Article  PubMed  Google Scholar 

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Assistance with the study: none. Financial support and sponsorship: none. The authors thank Jonathan S. Cronje for revising the manuscript with respect to grammar and style.

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Correspondence to D. Baumann.

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The mobile app was developed by D. Baumann with the help of W. Reip, J.C. Kubitz and N. Dibbern. For the remaining authors none were declared.



See Table 2.

Table 2 Overview of cases and frequency during the study

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Baumann, D., Dibbern, N., Sehner, S. et al. Validation of a mobile app for reducing errors of administration of medications in an emergency. J Clin Monit Comput 33, 531–539 (2019).

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