Clinical trial NCT03021122: Reducing Medication Errors and Time to Drugs Delivery During Pediatric Cardiopulmonary Resuscitation: a Multicenter RCT
Official title: Reducing Medication Errors and Time to Vasoactive Drugs Preparation and Delivery During Pediatric Cardiopulmonary Resuscitation: a Multicenter, Prospective, Randomized Controlled Trial
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Resuscitation
Pediatrics
Keywords: Medication errors
Resuscitation
Drugs
Pediatrics
Biomedical technology
Lead sponsor: Pediatric Clinical Research Platform
Sponsor class: OTHER
Collaborators: name: University of Geneva, Switzerland
name: University of Lausanne Hospitals
name: Insel Gruppe AG, University Hospital Bern
name: Neuchâtel Hospital, Neuchâtel, Switzerland
name: Fribourg Hospital, Fribourg, Switzerland
name: Sion Hospital, Sion, Switzerland
First posted: 2017-01-13
Enrollment: 130
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: CROSSOVER
Primary purpose: TREATMENT

Brief summary: The investigators recruit nurses working in 5 swiss Pediatric Emergency Departments or divisions to prepare continuous infusions of vasoactive drugs during a simulation-based pediatric CPR cardiac arrest scenario. According to randomization, nurses will have to prepare and deliver vasoactive drugs following their current conventional methods or by the aim of a mobile tablet application called PedAMINES™. PedAMINES™ is designed to support them step-by-step from order to delivery of these drugs.

1. Primary outcome will be to measure in each allocation group the number of medication dosage errors committed during each drug preparation sequence until injection.
2. Secondary outcome will be to measure the time to drug preparation (TDP) and time to drug delivery (TDD).

Detailed description: During pediatric cardiopulmonary resuscitation (CPR), vasoactive drug preparation for continuous infusion is both complex and time-consuming, placing children at higher risk than adults for medication errors. It is well established that CPR duration is inversely correlated to survival, decreasing linearly by 2.1 % per minute, and to decreased risk of neurological sequelae \[1\].

In this study, the investigators recruit nurses working in 5 swiss Pediatric Emergency Departments or divisions to prepare continuous infusions of vasoactive drugs during a simulation-based pediatric CPR cardiac arrest scenario with a high-fidelity manikin (Laerdal SimJunior™). The scenario will take place in the shock room to increase realism.

According to randomization with a 1:1 allocation ratio, nurses will have to prepare and deliver vasoactive drugs following their current conventional methods or by the aim of a mobile tablet application called PedAMINES™ (Pediatric Accurate Medication In Emergency Situations). PedAMINES™ is designed to support nurses step-by-step from order to delivery of a wide range of drugs, especially those requiring continuous infusion. PedAMINES™ has already been shown in a single-center simulation-based study to reduce time to vasoactive drug preparation, to delivery and the rate of medication errors \[2\].

On the day of participation, after obtaining nurse's written informed consent and randomization, nurses will receive a standardized 5-minute training session on how to use the app. Then, the nurses will be asked to perform a standardized 15-minute highly realistic CPR scenario, including post-return of spontaneous circulation (ROSC). After epinephrine-induced ROSC, nurses will be asked to first prepare a continuous infusion of dopamine, using either PedAMINES™ or a conventional method, and then a continuous infusion of norepinephrine by crossing the procedure. Moreover, 2 questionnaires will be given before and after the scenario to ask the nurses about their demographics data, perceived stress and degree of satisfaction.

1. Primary outcome will be to measure in each allocation group the number of medication dosage errors committed during each drug preparation sequence until injection.
2. Secondary outcome will be to measure the time to drug preparation (TDP) and time to drug delivery (TDD).

All the actions (i.e. primary and secondary outcomes) performed by the nurses during the scenario will be automatically recorded and stored by the responsive simulator detectors, the application and by several video cameras. To avoid assessment bias, two evaluators will then independently review these video recordings. In case of disagreement, a third independent evaluator will help reach a consensus.

We aim to determine whether the use of PedAMINES™ might improve the management of acute life-threatening conditions by quickly delivering expertise in vasoactive drugs administration in other hospitals in Switzerland, even in non-university hospitals where nurses (and physicians) are either little or not exposed to pediatric CPRs. We hypothesize that PedAMINES™ might primary reduce medication errors, and secondary reduce delays to drugs preparation and delivery independently of the existing conventional preparation methods or nurses' skills.

Eligibility criteria: Inclusion Criteria:

* To be nurse certified
* To know how to prepare intravenous drugs injection.
* To have previously completed the 5-minute introductory course to the use of PedAMINES dispensed by the investigators of the study.
* Participation agreement

Exclusion Criteria:

* To have at any time undergone a previous experiment with a cognitive numeric device aimed to help vasoactive drugs preparation.
* To have not undergone the 5-minute introductory course to the use of PedAMINES.

Primary outcomes:
measure: Medication dosage errors
timeFrame: On the day of study participation
Secondary outcomes:
measure: Time to drug preparation (TDP) and time to drug delivery (TDD)
timeFrame: On the day of study participation
Other outcomes:
Locations:
city: Sion
country: Switzerland
facility: Hôpital du Valais
state: Valais
city: Lausanne
country: Switzerland
facility: Hôpital de l'Enfance (HEL)
state: Vaud
city: Bern
country: Switzerland
facility: Inselspital Bern
city: Fribourg
country: Switzerland
facility: HFR Fribourg
city: Geneva
country: Switzerland
facility: Geneva Children's Hospital, Geneva University Hospitals
city: Neuchâtel
country: Switzerland
facility: Hôpital Neuchâtelois
Study officials:
affiliation: Geneva Children Hospital, Geneva University Hospitals, Geneva, Switzerland
name: Johan N Siebert, MD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Matos RI, Watson RS, Nadkarni VM, Huang HH, Berg RA, Meaney PA, Carroll CL, Berens RJ, Praestgaard A, Weissfeld L, Spinella PC; American Heart Association's Get With The Guidelines-Resuscitation (Formerly the National Registry of Cardiopulmonary Resuscitation) Investigators. Duration of cardiopulmonary resuscitation and illness category impact survival and neurologic outcomes for in-hospital pediatric cardiac arrests. Circulation. 2013 Jan 29;127(4):442-51. doi: 10.1161/CIRCULATIONAHA.112.125625. Epub 2013 Jan 22.
citation: Siebert JN, Ehrler F, Combescure C, Lacroix L, Haddad K, Sanchez O, Gervaix A, Lovis C, Manzano S. A Mobile Device App to Reduce Time to Drug Delivery and Medication Errors During Simulated Pediatric Cardiopulmonary Resuscitation: A Randomized Controlled Trial. J Med Internet Res. 2017 Feb 1;19(2):e31. doi: 10.2196/jmir.7005.
citation: Siebert JN, Gosetto L, Sauvage M, Bloudeau L, Suppan L, Rodieux F, Haddad K, Hugon F, Gervaix A, Lovis C, Combescure C, Manzano S, Ehrler F; PedAMINES Trial Group; PedAMINES Prehospital Group. Usability Testing and Technology Acceptance of an mHealth App at the Point of Care During Simulated Pediatric In- and Out-of-Hospital Cardiopulmonary Resuscitations: Study Nested Within 2 Multicenter Randomized Controlled Trials. JMIR Hum Factors. 2022 Mar 1;9(1):e35399. doi: 10.2196/35399.
citation: Siebert JN, Ehrler F, Combescure C, Lovis C, Haddad K, Hugon F, Luterbacher F, Lacroix L, Gervaix A, Manzano S; PedAMINES Trial Group. A mobile device application to reduce medication errors and time to drug delivery during simulated paediatric cardiopulmonary resuscitation: a multicentre, randomised, controlled, crossover trial. Lancet Child Adolesc Health. 2019 May;3(5):303-311. doi: 10.1016/S2352-4642(19)30003-3. Epub 2019 Feb 21.
citation: Siebert JN, Ehrler F, Lovis C, Combescure C, Haddad K, Gervaix A, Manzano S. A Mobile Device App to Reduce Medication Errors and Time to Drug Delivery During Pediatric Cardiopulmonary Resuscitation: Study Protocol of a Multicenter Randomized Controlled Crossover Trial. JMIR Res Protoc. 2017 Aug 22;6(8):e167. doi: 10.2196/resprot.7901.