www.ariasystems.com High-tech Pediatric Emergency Medicine: How technology can make your life easier? and your patient s life safer Johan N. Siebert, MD; Frédéric Ehrler, PhD; Christophe Combescure, PhD; Laurence Lacroix, MD; Kevin Haddada; Prof Alain Gervaix, MD; Prof Christian Lovis, MD; Sergio Manzano, MD
Background o In US pediatric emergency departments, immediate level 1 triage represents 175,000 consultations / year 6,700 to 15,000 require cardiopulmonary resuscitation (CPRs) o In addition, in-hospital cardiac arrest accounts for 5,800 to 10,000 CPRs annually
Probablity of outcome How technology can make your life easier? Time is life o During the first 15 minutes of CPR, survival and favorable neurological outcome decrease linearly by 2.1 % and 1.2 % per minute, respectively Survival to Hospital Discharge for in-hospital pediatric cardiac arrests CPR Duration (minutes) Matos RI et al. Circulation 2013
In this stressful environment, prolonged resuscitation time often results from drug preparation, especially in children where dosage is related to the the weight. Drug preparation can be a nightmare
Imagine. Translation Concentration: mg /ml Dosage: µg / kg /min Infusion rate: ml / min
Medication errors: - Higher in children than in adults - Reported in 41% of pediatric CPRs - 65% = incorrect medication dosage Porter E. et al. West J Emerg Med 2014
Pediatric Accurate Medication IN Emergency Situations innovative and customizable tablet application
To assess the hypothesis that PedAMINES might reduce: o drug preparation time and time to delivery, o medication errors during pediatric CPRs when compared to conventional preparation methods High-fidelity manikin
Reducing Medication Errors and Time to Drug Delivery during Pediatric CPR Type of study: o A prospective, opened randomized controlled crossover trial with two parallel groups comparing PedAMINES to a conventional drugs infusion rate table method during a standardized simulation-based pediatric post-cardiac arrest o Certified pediatric emergency nurses were eligible if they were actively practicing in our PED (n=20). o The study was approved by the institutional ethics committee
Flowchart How technology can make your life easier?
Results Manuscript submitted
UNIVERSITY OF GENEVA FACULTY OF MEDICINE
Time [sec] Time [sec] How technology can make your life easier? Results 800 Study Period 1 Dopamine **** *** PedAMINES Conventional method 400 Study Period 2 Norepinephrin * * Ped Con 600 300 400 200 200 100 0 DO ready DO ready DO delivery DO delivery 0 NE ready NE ready NE delivery NE delivery Time to... Time to... **** p < 0.0001 **** p < 0.01
Drug dose calculation was wrong but reached correct final dosage by chance. * Proportion of dosage with an error
Conclusions o PedAMINES : first app to drive nurses and physicians step-bystep from preparation to drug infusion delivery o Covers a full range of drug dosage for all pediatrics ages/weights o Multiplatform, customizable and inexpensive; worldwide available o Reduction in time to drug preparation and delivery o Dramatic reduction in medication errors o Better reactivity & autonomy with less cognitive load for the nurse in charge
o o o o o o o o Johan N. Siebert, MD; Frédéric Ehrler, PhD; Christophe Combescure, PhD; Laurence Lacroix, MD; Kevin Haddad; Sergio Manzano, MD Prof Christian Lovis, MD; Prof Alain Gervaix, MD;