Marcelyn Metz

Paramedic Self-Reported Medication Errors

Background. Continuing quality improvement (CQI) reviews reflect that medication administration errors occur in the prehospital setting. These include errors involving dose, medication, route, concentration, andtreatment. Methods. A survey was given to paramedics in San Diego County. The survey tool was established on the basis of previous literature reviews andquestions developed with previous CQI data. Results. A total of 352 surveys were returned, with the paramedics reporting a mean of 8.5 years of field experience. They work an average of 11.0 shifts/month with an average of 25.4 hours and6.7 calls/shift. Thirty-two (9.1%) responding paramedics reported committing a medication error in the last 12 months. Types of errors included dose-related errors (63%), protocol errors (33%), wrong route errors (21%), andwrong medication errors (4%). Issues identified in contributing to the errors include failure to triple check, infrequent use of the medication, dosage calculation error, andincorrect dosage given. Fatigue, training, andequipment setup of the drug box were not listed as any of the contributing factors. The majority of these errors were self-reported to their CQI representative (79.1%), with 8.3% being reported by the base hospital radio nurse, 8.3% found upon chart review, and4.2% noted by paramedic during call but never reported. Conclusions. Nine percent of paramedics responding to an anonymous survey report medication errors in the last 12 months, with 4% of these errors never having been reported in the CQI process. Additional safeguards must continue to be implemented to decrease the incidence of medication errors.

COMMUNITYTRIAL TODECREASEAMBULANCEDIVERSION OFPATIENTS ANDHOURS

the study site. Patients arriving by EMS had prehospital ECGs obtained, with the decision to activate the catheterization lab often made prior to patient arrival. Patients were grouped according to whether they presented during weekday working hours (0800 to 1800) or during off-hours (all other times). Catheterization lab personnel were typically on duty during business hours, but had to be called in during off-hours. Time intervals from emergency department arrival to balloon inflation were measured. Patients with nondiagnostic initial ECGs were excluded. Statistical analysis was performed using the Mann-Whitney U test. Results: A total of 142 AMI patients were taken for emergent angioplasty during the study period. Of these, 23 had nondiagnostic initial ECGs. Of the remaining 119 patients, 50 were treated during weekday business hours and 69 were treated during off-hours. The mean door to balloon time during business hours was 69 minutes (median 65 minutes, range 36–227 minutes). The mean door to balloon time during off-hours was 107 minutes (median 90 minutes, range 46–595 minutes). These differences are significant (p, 0.0000). Conclusion: The mean and median door to balloon times differ significantly between business hours and off-hours. Because these differences may impact outcome, it is imperative that EMS provide advance notification of arrival so that the cardiac catheterization lab can be readied for patient arrival. This need for advance notification is especially important during off hours.