Implementation of a Pediatric Emergency Drug Dosage Booklet

Aim: : Emergency Department (ED) nurses are uncomfortable with the administration of medications during pediatric emergencies. The current process of obtaining a pre-calculated, weight-based dosing tool is inefficient, and access is unclear.

The purpose of this quality improvement project is to improve caregiver confidence with medication administration during pediatric emergencies through implementation of a pre-calculated, weight-based drug dosage tool.

Framework:: This project was guided by the Kellogg Logic Model for project planning. The Donabedian Model was used to implement this project. Plan Do Study Act (PDSA) cycles were used to test change.

Setting:: Midwest, urban, academic medical center ED with 75,000 patient visits per year. Pediatric patients (17 years and younger) account for 10% of total ED visits. Approximately 12 pediatric emergencies occur each year.

Stakeholder Team:: The project leader constructed the pre-and-post-implementation survey, conducted staff education and facilitated simulations. The ED Pharmacist created the pre-calculated, weight-based, drug dosage booklet (Booklet). The ED Pharmacist and project leader completed Booklet revisions. The ED Director and Educator gave permission for simulations to be embedded in nurse education days.

Methods: : The Booklet was created to be readily accessible for ED staff to use during pediatric emergencies to streamline the medication administration process and improve caregiver confidence.

A pre-and-post-survey was provided to ED nurses and pharmacy residents regarding confidence during pediatric emergencies. Simulation was used to measure provider confidence and observe medication administration pre-and post-Booklet implementation. A total of 32 one-hour pediatric simulations took place with 112 ED RN participants. During simulations, qualitative data was obtained. Medication errors during simulation were tracked. A questionnaire was provided to staff seeking Booklet feedback. The number of pediatric emergencies post implementation and booklet utilization were tracked.

Outcomes:: The Booklet was utilized for 83% of pediatric emergencies. The feedback questionnaire showed 100% of staff felt the Booklet was readable, easy to use and locate.

Notable differences in the pre-and-post-confidence survey were the comfort level during pediatric emergencies, comfort level with medication administration, and awareness/access of drug dosing tools. Those somewhat comfortable during pediatric emergencies increased from 47% to 70%. Not at all comfortable decreased from 42.5% to 21.6%. Extremely comfortable improved from 15% to 24%. Not at all comfortable decreased from 25% to 13.5%.

Medication errors during simulation remained nearly unchanged when the Booklet was utilized. A medication error occurred in 88% of the first sixteen simulations (no Booklet) and in 81% (13/16) of the second sixteen simulations (with Booklet). The simulation scenario was written with an intentional request for an incorrect dose. Most nurses were hesitant to correct the provider even if they felt the dose was incorrect.

In 100% of simulations, at least one nurse expressed discomfort of pediatric emergencies, unsolicited. Likewise, in 100% of simulations, at least one nurse expressed new pediatric knowledge after the simulation.

Implications:: Using an evidence-based, weight-based, pre-calculated, pediatric drug dosing booklet enhances provider confidence. Caregivers reported simulation activities as an effective means to test usefulness of tools and practice skills in a safe setting. When new processes are implemented, staff require time to practice and solidify the new procedure.