How to avoid epinephrine dosing errors in infants? JAMA study provides insight

USA: A simple emergency medical services (EMS) intervention employing a 1-mL syringe for tiny epinephrine doses was linked to a higher rate of proper epinephrine dose administration without lowering delivery speed, says an article published in the Journal of American Medical Association.

Because of the potential for decimal translation errors (leading to 10-fold errors) and the inaccuracy in providing lower doses using frequently provided (1 mg/10 mL) prefilled epinephrine syringes, the smallest children are at the highest risk of epinephrine dosing errors. As a result, Matt Hansen and colleagues undertook this study to see if a simulation-driven emergency medical services protocol change that uses a 1-mL syringe to provide tiny epinephrine doses lowers dosage errors in newborns.

Researchers ran simulations in two separate time periods for this quality improvement study, and data were collected in real-time during the simulation situations. The SQUIRE reporting requirements were followed for this study. All simulations were carried out in real-time, with the same infant simulator and EMS agencies in a large regional EMS system where complex life support–capable public fire and private transfer units react to all calls for service. To compare the 2016 and 2020 data, a 2-tailed Fisher exact test was used; this test was chosen due to the very small sample sizes. Stata version 15 was used for all statistical analyses.