Effect of a Mobile App on Medication Errors During Simulated Pediatric Cardiopulmonary Resuscitation: PEDIDOSIS App vs. Conventional Methods. A Multicenter Simulation-based Randomized Controlled Trial

Despite its low incidence, pediatric cardiopulmonary arrest remains associated with high mortality and morbidity. The adequate preparation and administration of drugs can impact favourably on the outcomes of cardiopulmonary resuscitation. Nursing staff rely on cognitive aids such as paper support, calculators, or spreadsheets to ensure correct drug administration. Numerous strategies have been proposed to prevent medication errors, including the emergence of mHealth. This study evaluates the efficacy and usefulness of the PEDIDOSIS smartphone application (app) for nursing staff in a simulated pediatric emergency setting. A multicentre high-fidelity simulation-based randomized controlled trial was conducted in a pediatric emergency setting with nursing professionals from different hospitals in Spain. Randomisation groups: PEDIDOSIS app (La Paz Hospital, Spain) vs. conventional methods (such as printed or electronic medication tables, smartphones, calculators or no cognitive aid). To avoid bias due to differences in pediatric emergency experience, each group was randomly assigned the same number of participants with experience (> 5 years) and without experience (≤ 5 years). Epinephrine, bicarbonate, midazolam, and norepinephrine on two ocassions were administered in a simulation scenario. Number and magnitude of medication errors, time taken to drug administration were evaluated as measured with video recording; stress, satisfaction, and usability as measured using standardized survey tools were evaluated. One-hundred and five nurses participated. The incidence of wrong dose administration by any deviation from the correct dose was 51.5% for the control group vs. 26.4% for the PEDIDOSIS app group (p < 0.001). The OR for a wrong dose administration > 10% deviation with PEDIDOSIS app vs. conventional methods was 0.24 [0.14-0.4]), with a risk difference of 20.7%. The proportion of participants committing several medication errors (ME) was substantially lower with the app (15.1%) than with conventional methods (57.7%). Overall satisfaction regarding drug preparation was higher and stress lower in the app group. The System Usability Scale (SUS) score obtained for PEDIDOSIS app was 78.9 out of 100.