Background: Prehospital pediatric drug dosing errors occur at a high rate. Multiple factors contribute to these errors. The contribution of weight estimation errors to drug dosing errors is unknown. We describe methods used to obtain weights and resulting drug dosing errors. Methods: As part of a quality improvement study in 16 EMS agencies, we conducted four simulated pediatric scenarios: seizing, hypoglycemic infant, infant cardiac arrest, 18-month old burn and a 5-year old with anaphylactic shock. Crews used their regular drug bags and equipment. Simulations were observed by study team members with video review and scored on a standardized scoring sheet. Results: 142 scenarios were completed. Methods to obtain patient weights were: asking parent 17/142 (12.0%), patient age 35/142 (24.8%) and Broselow-Luten Tape (BLT) 89/142 (63.1%). There were 19 (13.4% 95% CI 8.5, 20.0) incorrect weight estimations resulting in 18 (12.7% 95% CI 8.2, 19.2) dosing errors (1 asking parent, 9 patient age and 8 BLT). Ten dosing errors were directly caused by weight estimation errors. In 41/89 (46.1% 95%CI 36.1, 56.4) BLT uses there was a near-miss error that did not result in a dosing error. One pound to kilogram conversion error occurred. Conclusions: BLT is the most frequently used method to obtain a patient weight. Drug dosing errors were most frequent with patient age, followed by BLT and asking the parent. System-based solutions-weight determination hierarchy, not using the BLT on seated patients, and more frequent training and practice with the BLT-are needed to improve drug-dosing accuracy.
Keywords: drug dosing errors; emergency medical services; patient safety; patient weight estimation; pediatric.