A Pre- and Post-intervention Comparison of Drug Prescribing and Equipment Sizing Practices During Emergency Resuscitations in the Paediatric Intensive Care Unit at Kenyatta National Hospital

Abstract

Background: Prescription practices in paediatrics are weight-based. Errors in inappropriate drug dosing are the most common. These errors may have dire consequences in emergency resuscitations. The importance of correct paediatric weight-based drug dosages has been studied in clinical and simulation contexts. The harms of potential over-and under-dosing of life-saving emergency drugs are well-understood. Broad objective: To determine the effect of introducing a resuscitation aid among health care workers during emergency resuscitations in the paediatric intensive care unit (PICU) at Kenyatta National Hospital (KNH). Study design and site: This was a prospective quasi-experimental study conducted in PICU at KNH. Study participants and methods: The study participants were health workers in PICU. Consecutive sampling was employed. The sample included 52 staff members. A standardized questionnaire was used in data collection. Data analysis A total of 52 participants took part in this study. Of the total participants, 75% were females while the rest were males. Nurses made up the majority cadre, 71.2% followed by medical officers at 9.6%. More than 85% of the participants had more than 5 years of clinical experience both before and after training. The median age of the participants was 32.0 years with an interquartile range of 28.8 to 38.0 years. The majority of the participants were trained in PALS/EPALS, 51.9% both in the pre-and post-training periods. In terms of equipment selection, 63.5% and 59.6% of the respondents were able to identify the right size of the Ambu bag in the pre-and post-intervention periods respectively. Discussion Our study showed that 75% and 76.9% for pre-intervention and post-intervention periods respectively referred for drug doses. Simulation studies have shown 25.4% lower incidences of deviations from the recommended dose ranges among clinicians who refer compared to the non-referring ones (control group). This study found that 63.5% and 59.6% in the preintervention and post-intervention periods respectively were able to select the right size of Ambu bag and mask for ventilation during resuscitation. While there were no exact studies to compare with the above findings, simulation trials have found equipment size deviations of up to 2 different sizes. Conclusion The uptake of drug and equipment reference aid is high among health workers in paediatric intensive care unit. Despite the reference aids being used, deviations still exist in selection of equipment during resuscitation.