Mobile App Substantially Decreases Medication Errors, Delivery Time

Use of a mobile app significantly decreases the rate of medication errors and time to drug delivery for emergency drug preparation in a prehospital setting.

Findings of the recent study suggest such apps have the potential to improve medication safety and change practices in pediatric emergency medicine.

Johan N. Siebert, M.D., and a team of Switzerland-based investigators assessed the efficacy of an evidence-based mobile app in reducing the occurrence of medication errors compared with conventional preparation methods during simulated pediatric out-of-hospital cardiac arrest scenarios. The nationwide, open-label, multicenter, randomized clinical trial took place at 14 emergency medical services centers in Switzerland.

Two methods were evaluated to guide the preparation of emergency drugs for IV administration at pediatric doses. Those included in the study were randomly assigned to prepare the drugs with support of the app (intervention group) or by conventional methods (control group).

Participants were registered advanced paramedics who worked in EMS and had a three-year formal educational program in Switzerland. Paramedics were trained in advanced life support procedures.

Those randomized to the intervention group needed to: (1) complete a survey collecting data about their demographic characteristics, healthcare training, and simulation and computer experience; (2) attend a five-minute training session on how to use the app; and (3) attend a presentation of the simulation manikin characteristics. Paramedics participated in a simulated cardiopulmonary resuscitation scenario on a high-fidelity manikin. The scenario was filmed to be analyzed to verify whether any errors were made.

In the scenario, participants were asked to sequentially prepare and inject four different drugs of varying degrees of preparation difficulty with the support of the mobile app designed to assist with drug preparation. Those in the control group followed conventional pediatric drug preparation methods.

The team’s primary outcome was medication error, defined as failure in drug preparation if at least one error was committed — a deviation in drug dose higher than 10% from the correct weight dose, inability to calculate drug dose without guidance from the paramedic investigator leading the resuscitation room, or a deviation of higher than 10% of the final administered concentration of sodium bicarbonate from the prescribed 4.2% concentration.

There were 150 advanced paramedics randomized to the two study groups — 74 to the mobile app group and 76 to the conventional group.

Overall, 600 drug doses were delivered. More than 62% of doses given using the conventional method and 5.7% of those delivered using the mobile app were associated with medication errors. A majority of errors were due to a dose deviation higher than 10% of the prescribed dose (56.6% using the conventional method and 5.4% using the mobile app). The risk of incorrect preparation of the four drugs was decreased by 66.5% using the mobile app.

All participants in the control group committed at least one preparation error during the scenario, while 18.9% of the intervention group had at least one error. The proportion of those committing several preparation errors was substantially lower with the app (4.1%) than with the conventional method (85.5%).

Use of the mobile app resulted in significantly shorter times for drug preparation and delivery. Such was observed for three of the drugs. The time to drug preparation decreased by 40 seconds and the time to drug delivery decreased by 47 seconds. The decreases represented an overall saving in time of 20% compared with the conventional method.

The study findings emphasized the efficacy and positive outcomes related to medical mobile apps to improve medication safety and change prehospital clinical practice in pediatric emergency medicine.

The study, “Effect of a Mobile App on Prehospital Medication Errors During Simulated Pediatric Resuscitation,” was published online in JAMA Network Open.