A multidisciplinary approach to reducing medication errors through paediatric medical emergency simulation.

Abstract

Background

Medical emergencies are often chaotic situations requiring quick decision-making and rapid administration of medicines, which can contribute to errors. The Institute for Safe Medication Practices (ISMP) recommends conducting regular simulation exercises with appropriately trained pharmacists to decrease the risk of medication errors during emergencies.

Objectives/Aims

To improve the safe use of medicines during paediatric medical emergencies through multidisciplinary team (MDT) observation at regular simulation exercises.

Method

Monthly in situ medical emergency simulation exercises are held in the Department of Paediatrics at a regional hospital involving paediatric medical and nursing staff, the Medical Emergency Team (MET) and education staff. The paediatric pharmacist is invited to attend as part of the education team. Recommendations from the exercise are considered for system improvement at a departmental and organizational level. The exercise is repeated following implementation of risk reduction strategies to assess improvement.

Results

The MDT has conducted monthly simulation exercises over a 12-month period which have resulted in the implementation of several risk reduction strategies at a local level, including standardisation of verbal medication ordering processes during emergencies; improved availability of emergence drug resources and paediatric response trolley review including provision of medicines in ready-to-use syringes where possible. The addition of adrenaline auto injectors to the paediatric response trolley has reduced medication selection and preparation errors plus the time to adrenaline administration during repeated anaphylaxis simulation exercises from 10 minutes to less than 1 minute. Similarly time to antibiotic administration in neonatal early onset sepsis, and time to administration of intubation medications have been reduced following implementation of system improvements resulting from repeated simulation exercises.

Implications/Outcomes for Planned Research Project

Utilising the expertise of the MDT in direct observation allows for identification of human factors that contribute to errors as well as opportunities to improve systems, and is effective in facilitating practice change in readiness for real events.

Final Thoughts

A multidisciplinary approach to clinical simulation allows for broader analysis of system changes required to enhance medication safety during management of rapidly deteriorating paediatric patients.