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Comparing the Effectiveness of a Clinical Decision Support Tool in Reducing Pediatric Opioid Dose Calculation Errors: PediPain App vs. Traditional Calculators – A Simulation-Based Randomised Controlled Study

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Abstract

Wrong dose calculation medication errors are widespread in pediatric patients mainly due to weight-based dosing. PediPain app is a clinical decision support tool that provides weight- and age- based dosages for various analgesics. We hypothesized that the use of a clinical decision support tool, the PediPain app versus pocket calculators for calculating pain medication dosages in children reduces the incidence of wrong dosage calculations and shortens the time taken for calculations. The study was a randomised controlled trial comparing the PediPain app vs. pocket calculator for performing eight weight-based calculations for opioids and other analgesics. Participants were healthcare providers routinely administering opioids and other analgesics in their practice. The primary outcome was the incidence of wrong dose calculations. Secondary outcomes were the incidence of wrong dose calculations in simple versus complex calculations; time taken to complete calculations; the occurrence of tenfold; hundredfold errors; and wrong-key presses. A total of 140 residents, fellows and nurses were recruited between June 2018 and November 2019; 70 participants were randomized to control group (pocket calculator) and 70 to the intervention group (PediPain App). After randomization two participants assigned to PediPain group completed the simulation in the control group by mistake. Analysis was by intention-to-treat (PediPain app = 68 participants, pocket calculator = 72 participants). The overall incidence of wrong dose calculation was 178/576 (30.9%) for the control and 23/544 (4.23%) for PediPain App, P < 0·001. The risk difference was − 32.8% [-38.7%, -26.9%] for complex and − 20.5% [-26.3%, -14.8%] for simple calculations. Calculations took longer within control group (median of 69 Sects. [50, 96]) compared to PediPain app group, (median 48 Sects. [38, 63]), P < 0.001. There were no differences in other secondary outcomes. A weight-based clinical decision support tool, the PediPain app reduced the incidence of wrong doses calculation. Clinical decision support tools calculating medications may be valuable instruments for reducing medication errors, especially in the pediatric population.

Key Points

  • Question: Can a clinical decision support tool app decrease opioids and pain medications’ wrong dose calculations errors in the pediatric patients compared to a calculator and reference book?.

  • Findings: A weight-based clinical decision support tool, the PediPain app, reduced the incidence of wrong doses calculations compared to the use of a calculator and reference handbook.

  • Meaning: Our study demonstrates the potential for favorable clinical outcomes that clinical decision support tools could bring to the medical field, especially for clinical situations with a high cognitive workload.

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Data Availability

Data cannot be shared openly but are available on request from authors.

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Authors and Affiliations

  1. Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada

    Clyde T. Matava, Martina Bordini, Amanda Jasudavisius, Carmina Santos & Monica Caldeira-Kulbakas

  2. Department of Anesthesiology and Pain Medicine, Faculty of Medicine, University of Toronto, Toronto, ON), Canada

    Clyde T. Matava & Martina Bordini

  3. Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy

    Martina Bordini

  4. Department of Anesthesiology and Perioperative Medicine, Kingston Health Sciences Centre, Kingston, ON), Canada

    Amanda Jasudavisius

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  1. Clyde T. Matava
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  4. Carmina Santos
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  5. Monica Caldeira-Kulbakas
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Contributions

C.T.M conceived the study. C.T.M and M.B. wrote the main manuscript text. All authors reviewed the manuscript.

Corresponding author

Correspondence to Clyde T. Matava.

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Ethics Approval and Consent to Participate

This prospective randomised controlled trial received approval from the Hospital for Sick Children Research Ethics Board (1000057059). All participants provided written informed consent.

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The authors declares that they have no conflicts of interest.

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Matava, C.T., Bordini, M., Jasudavisius, A. et al. Comparing the Effectiveness of a Clinical Decision Support Tool in Reducing Pediatric Opioid Dose Calculation Errors: PediPain App vs. Traditional Calculators – A Simulation-Based Randomised Controlled Study. J Med Syst 48, 43 (2024). https://doi.org/10.1007/s10916-024-02060-4

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