Pediatric Emergencies and Resuscitation Color Coding Kids to optimize patient safety
Susan Hohenhaus, RN Project Manager Duke University Medical Center Department of Pediatric Emergency Medicine EMSC Enhancing Pediatric Patient Safety Grant Karen Frush, MD, PI
Objective... To teach emergency care providers the importance of standardization in pediatric resuscitation and to identify systems that can enhance pediatric patient safety using color as a common language
A Day in the Life Six month old admitted for evaluation of new onset seizures ED has run labs and started # 22 gauge IV with maintenance fluids, has been stable; no seizures noted in ED During admission nursing assessment, child begins to seize; respirations decrease; blue around lips
Panic is contagious Someone get me some help His mom doesn t know how much he weighs What s the weight on the ER record? They re sending it back up to us now. How much does a 6 month old weigh? I think it s age in years times 6 plus 12 or is it age in years times 12 plus 6? I think he looks about pounds
His IV just pulled out of his hand! What size catheter should I use? His color looks terrible Where s the ambu bag? What size mask?
Get me out of here! How much lorazepam? 0.1 ml/kg equals dose in mls....or was it 0.01 ml/kg dose in mls?...or was it 0.1 mg/kg dose in mgs? someone bring me the code sheets I m looking for the book can t you print out a resus sheet I need the weight
There s got to be an easier way! Dr. Jim Broselow: tape development in early 1980 s. Color-code ranges Showed a direct correlation between weight and length in the pediatric population
Pediatric Patient Safety Issues Institute of Medicine Report 12/99 To Err is Human : est. 44,000-98,000 people die each year as a result of medical errors 50% reduction within 5 years Interest in error reduction for pediatric patients regarding medication and equipment
Lesar,, TS. Arch Pediatr Adolesc Med 1998 Apr;152(4):340-4 Medication error rate in tertiary care teaching hospital Greatest areas: Peds; ; ED Errors in decimal point placement, mathematical calculation, or expression of dosage regimen accounted for 59.5% of dosage errors.
Kaushal,, et al. Medication errors and adverse drug events in pediatric inpatients. JAMA April 2001 Children s Hospital 5.7% of orders had medication errors Most potential Adverse Drug Events occurred at the stage of drug ordering (79%) and involved incorrect dosing (34%); (intravenous medications 54%).
Resuscitation for Dummies? Use of the Tape actually elevates critical thinking Reduces cognitive load Allows Focus To Be On: Assessment Prioritization Intervention Feedback
Color Coding as Error Prevention Eliminates Memorization Eliminates Mathematics Promotes Standardization Provides Redundancy and Universality
Goals of Duke EPPS project: through preparation, organization and standardization Decreased Pediatric Emergency Care Errors Increased efficiency in treating kids Decreased Clinician Anxiety Nursing most vulnerable Nurses are safety net for system No safety net for nurses
Resuscitation Scenario should go Measure Child and Assign Color Zone Child measures in Broselow red I need the red Ambu mask Give him a red dose of Midazolam like this:
Standardize by Color Organize generally Identify Individually
Build systems to enhance
The Primary Alphabet Airway Breathing Circulation Disability Exposure C-Spine Delay color becomes a vital sign Color
The Correct Use of the Tape Place Showing Color Side for Care
Red arrow at the top of the head
Place on flat surface next to supine child hand running along the length of the tape from head to patient s heel.
Hand on tape adjacent to patient s heel identifying patients weight and color zone.
This child measures Broselow Green
All Resuscitation Efforts are now referred to by color zone Broselow Blue equipment Broselow Blue Dose of Medication Broselow Blue Protocol
Thanks to all from your North Carolina EMS for Children Colleagues