Prevalence of Errors in Anaphylaxis in Kids (PEAK): A Multicenter Simulation-Based Study
| Autor: | Christie M Gutierrez, Becky Damazo, Adrian Zurca, Priti Jani, Tensing Maa, Trish Wood, Caroline Andler, Rana Sharara-Chami, Christina Cochran, Danielle Mercurio, Elizabeth A. Hunt, Renee England, Antonio Rodriguez-Nunez, Robyn Wing, Tali Capua, Elizabeth Biddell, Anja Grosse Lordemann, Jennifer Muñoz-Pareja, Susan Teman, Maria Carmen G. Diaz, Marc Auerbach, Lynda Knight, Carisa Schneider, Sushant Srinivasan, Daniel J. Scherzer, Joo Lee Song, Ilana Harwayne-Gidansky, Kamal Abulebda, Jared W. Henricksen, Ellen S. Deutsch, David Kessler, Michelle Gaba, Elizabeth Vukin, Benny L. Joyner, Jennifer L. Trainor |
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| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Epinephrine 03 medical and health sciences 0302 clinical medicine Interquartile range Autoinjector Health care Prevalence Immunology and Allergy Medicine Humans Medication Errors Epinephrine autoinjector 030212 general & internal medicine Prospective Studies Formulary Child Anaphylaxis business.industry Emergency department medicine.disease 030228 respiratory system Emergency medicine business medicine.drug |
| Zdroj: | The journal of allergy and clinical immunology. In practice. 8(4) |
| ISSN: | 2213-2201 |
| Popis: | Background Multi-institutional, international practice variation of pediatric anaphylaxis management by health care providers has not been reported. Objective To characterize variability in epinephrine administration for pediatric anaphylaxis across institutions, including frequency and types of medication errors. Methods A prospective, observational, study using a standardized in situ simulated anaphylaxis scenario was performed across 28 health care institutions in 6 countries. The on-duty health care team was called for a child (patient simulator) in anaphylaxis. Real medications and supplies were obtained from their actual locations. Demographic data about team members, institutional protocols for anaphylaxis, timing of epinephrine delivery, medication errors, and systems safety issues discovered during the simulation were collected. Results Thirty-seven in situ simulations were performed. Anaphylaxis guidelines existed in 41% (15 of 37) of institutions. Teams used a cognitive aid for medication dosing 41% (15 of 37) of the time and 32% (12 of 37) for preparation. Epinephrine autoinjectors were not available in 54% (20 of 37) of institutions and were used in only 14% (5 of 37) of simulations. Median time to epinephrine administration was 95 seconds (interquartile range, 77-252) for epinephrine autoinjector and 263 seconds (interquartile range, 146-407.5) for manually prepared epinephrine (P = .12). At least 1 medication error occurred in 68% (25 of 37) of simulations. Nursing experience with epinephrine administration for anaphylaxis was associated with fewer preparation (P = .04) and administration (P = .01) errors. Latent safety threats were reported by 30% (11 of 37) of institutions, and more than half of these (6 of 11) involved a cognitive aid. Conclusions A multicenter, international study of simulated pediatric anaphylaxis reveals (1) variation in management between institutions in the use of protocols, cognitive aids, and medication formularies, (2) frequent errors involving epinephrine, and (3) latent safety threats related to cognitive aids among multiple sites. |
| Databáze: | OpenAIRE |
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