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Review article: Biomedical intelligence

Vol. 150 No. 3536 (2020)

PedAMINES: a disruptive mHealth app to tackle paediatric medication errors

DOI
https://doi.org/10.4414/smw.2020.20335
Cite this as:
Swiss Med Wkly. 2020;150:w20335
Published
25.08.2020

Abstract

Medication errors are among the most common medical adverse events and an important cause of patient morbidity and mortality, affecting millions of people worldwide each year. This problem is especially acute in paediatric settings, where most drugs given intravenously to children are provided in vials prepared for the adult population. This leads to the need for a specific, individual, weight-based drug-dose calculation and preparation for each child, which varies widely across age groups. This error-prone process places children at a high risk for life-threatening medication errors, particularly in stressful and critical situations, such as cardiopulmonary resuscitation. To limit and mitigate the likelihood of their occurrence, hospitals are increasingly adopting eHealth interventions aimed at supporting and securing each individual stage along the whole medication process, but there is mixed evidence regarding their positive contribution. These technologies are helpful as long as they are used within the scope of their application and users are aware of their limitations, as their introduction has sometimes led to new, often unforeseen, types of errors.

The aim of the present work is to provide an overview of some of the main eHealth interventions used across the various stages of the medication process and to highlight areas that require attention in order to implement successful digital technologies. More specifically, the contribution of eHealth technologies in paediatrics is discussed, including the out-of-hospital setting, as well as barriers to their implementation in low- and middle-income countries. Finally, we describe our own work in this field with regards to the development and use of an innovative, evidence-based mobile device application (PedAMINES) to address the unmet need of reducing paediatric medication errors, especially during cardiopulmonary resuscitation. The PedAMINES app has also the potential to make a very effective contribution to the goals of the Third World Health Organization Global Patient Safety Challenge to reduce severe, avoidable medication-associated harm by 50% in all countries over the next 5 years, including low- and middle-income countries.

References

  1. Donaldson LJ, Kelley ET, Dhingra-Kumar N, Kieny MP, Sheikh A. Medication without harm: WHO’s third global patient safety challenge. Lancet. 2017;389(10080):1680–1. doi:.https://doi.org/10.1016/S0140-6736(17)31047-4
  2. Leape LL, Bates DW, Cullen DJ, Cooper J, Demonaco HJ, Gallivan T, et al.; ADE Prevention Study Group. Systems analysis of adverse drug events. JAMA. 1995;274(1):35–43. doi:.https://doi.org/10.1001/jama.1995.03530010049034
  3. Weant KA, Bailey AM, Baker SN. Strategies for reducing medication errors in the emergency department. Open Access Emerg Med. 2014;6:45–55. doi:.https://doi.org/10.2147/OAEM.S64174
  4. Austin JA, Smith IR, Tariq A. The impact of closed-loop electronic medication management on time to first dose: a comparative study between paper and digital hospital environments. Int J Pharm Pract. 2018;26(6):526–33. doi:.https://doi.org/10.1111/ijpp.12432
  5. Bhatti S. Adoption of closed loop medicines administration into the NHS. Pharm J. 2019. Available at: https://www.pharmaceutical-journal.com/opinion/blogs/adoption-of-closed-loop-medicines-administration-into-the-nhs/20206864.blog?firstPass=false.
  6. Ranji SR, Rennke S, Wachter RM. Computerised provider order entry combined with clinical decision support systems to improve medication safety: a narrative review. BMJ Qual Saf. 2014;23(9):773–80. doi:.https://doi.org/10.1136/bmjqs-2013-002165
  7. Radley DC, Wasserman MR, Olsho LE, Shoemaker SJ, Spranca MD, Bradshaw B. Reduction in medication errors in hospitals due to adoption of computerized provider order entry systems. J Am Med Inform Assoc. 2013;20(3):470–6. doi:.https://doi.org/10.1136/amiajnl-2012-001241
  8. Kaushal R, Shojania KG, Bates DW. Effects of computerized physician order entry and clinical decision support systems on medication safety: a systematic review. Arch Intern Med. 2003;163(12):1409–16. doi:.https://doi.org/10.1001/archinte.163.12.1409
  9. Shamliyan TA, Duval S, Du J, Kane RL. Just what the doctor ordered. Review of the evidence of the impact of computerized physician order entry system on medication errors. Health Serv Res. 2008;43(1 Pt 1):32–53. doi:.https://doi.org/10.1111/j.1475-6773.2007.00751.x
  10. Eslami S, de Keizer NF, Abu-Hanna A. The impact of computerized physician medication order entry in hospitalized patients--a systematic review. Int J Med Inform. 2008;77(6):365–76. doi:.https://doi.org/10.1016/j.ijmedinf.2007.10.001
  11. van Rosse F, Maat B, Rademaker CM, van Vught AJ, Egberts AC, Bollen CW. The effect of computerized physician order entry on medication prescription errors and clinical outcome in pediatric and intensive care: a systematic review. Pediatrics. 2009;123(4):1184–90. doi:.https://doi.org/10.1542/peds.2008-1494
  12. Nuckols TK, Smith-Spangler C, Morton SC, Asch SM, Patel VM, Anderson LJ, et al. The effectiveness of computerized order entry at reducing preventable adverse drug events and medication errors in hospital settings: a systematic review and meta-analysis. Syst Rev. 2014;3(1):56. doi:.https://doi.org/10.1186/2046-4053-3-56
  13. Prgomet M, Li L, Niazkhani Z, Georgiou A, Westbrook JI. Impact of commercial computerized provider order entry (CPOE) and clinical decision support systems (CDSSs) on medication errors, length of stay, and mortality in intensive care units: a systematic review and meta-analysis. J Am Med Inform Assoc. 2017;24(2):413–22. doi:.https://doi.org/10.1093/jamia/ocw145
  14. Sethuraman U, Kannikeswaran N, Murray KP, Zidan MA, Chamberlain JM. Prescription errors before and after introduction of electronic medication alert system in a pediatric emergency department. Acad Emerg Med. 2015;22(6):714–9. doi:.https://doi.org/10.1111/acem.12678
  15. Potts AL, Barr FE, Gregory DF, Wright L, Patel NR. Computerized physician order entry and medication errors in a pediatric critical care unit. Pediatrics. 2004;113(1):59–63. doi:.https://doi.org/10.1542/peds.113.1.59
  16. Sard BE, Walsh KE, Doros G, Hannon M, Moschetti W, Bauchner H. Retrospective evaluation of a computerized physician order entry adaptation to prevent prescribing errors in a pediatric emergency department. Pediatrics. 2008;122(4):782–7. doi:.https://doi.org/10.1542/peds.2007-3064
  17. Vardi A, Efrati O, Levin I, Matok I, Rubinstein M, Paret G, et al. Prevention of potential errors in resuscitation medications orders by means of a computerised physician order entry in paediatric critical care. Resuscitation. 2007;73(3):400–6. doi:.https://doi.org/10.1016/j.resuscitation.2006.10.016
  18. Patel VL, Kannampallil TG. Human factors and health information technology: current challenges and future directions. Yearb Med Inform. 2014;9:58–66. doi:.https://doi.org/10.15265/IY-2014-0005
  19. Han YY, Carcillo JA, Venkataraman ST, Clark RS, Watson RS, Nguyen TC, et al. Unexpected increased mortality after implementation of a commercially sold computerized physician order entry system. Pediatrics. 2005;116(6):1506–12. doi:.https://doi.org/10.1542/peds.2005-1287
  20. Slight SP, Eguale T, Amato MG, Seger AC, Whitney DL, Bates DW, et al. The vulnerabilities of computerized physician order entry systems: a qualitative study. J Am Med Inform Assoc. 2016;23(2):311–6. doi:.https://doi.org/10.1093/jamia/ocv135
  21. Korb-Savoldelli V, Boussadi A, Durieux P, Sabatier B. Prevalence of computerized physician order entry systems-related medication prescription errors: A systematic review. Int J Med Inform. 2018;111:112–22. doi:.https://doi.org/10.1016/j.ijmedinf.2017.12.022
  22. Carli D, Fahrni G, Bonnabry P, Lovis C. Quality of decision support in computerized provider order entry: systematic literature review. JMIR Med Inform. 2018;6(1):e3. doi:.https://doi.org/10.2196/medinform.7170
  23. Koppel R, Metlay JP, Cohen A, Abaluck B, Localio AR, Kimmel SE, et al. Role of computerized physician order entry systems in facilitating medication errors. JAMA. 2005;293(10):1197–203. doi:.https://doi.org/10.1001/jama.293.10.1197
  24. Kahn S, Abramson EL. What is new in paediatric medication safety? Arch Dis Child. 2019;104(6):596–9. doi:.https://doi.org/10.1136/archdischild-2018-315175
  25. Grissinger M. Safeguards for Using and designing automated dispensing cabinets. P&T. 2012;37(9):490–530.
  26. Cottney A. Improving the safety and efficiency of nurse medication rounds through the introduction of an automated dispensing cabinet. BMJ Qual Improv Rep. 2014;3(1):u204237.w1843. doi:.https://doi.org/10.1136/bmjquality.u204237.w1843
  27. Tsao NW, Lo C, Babich M, Shah K, Bansback NJ. Decentralized automated dispensing devices: systematic review of clinical and economic impacts in hospitals. Can J Hosp Pharm. 2014;67(2):138–48. doi:.https://doi.org/10.4212/cjhp.v67i2.1343
  28. Paparella S. Automated medication dispensing systems: not error free. J Emerg Nurs. 2006;32(1):71–4. doi:.https://doi.org/10.1016/j.jen.2005.11.004
  29. Barker KN, Flynn EA, Pepper GA, Bates DW, Mikeal RL. Medication errors observed in 36 health care facilities. Arch Intern Med. 2002;162(16):1897–903. doi:.https://doi.org/10.1001/archinte.162.16.1897
  30. Moreira ME, Hernandez C, Stevens AD, Jones S, Sande M, Blumen JR, et al. Color-coded prefilled medication syringes decrease time to delivery and dosing error in simulated emergency department pediatric resuscitations. Ann Emerg Med. 2015;66(2):97–106.e3. doi:.https://doi.org/10.1016/j.annemergmed.2014.12.035
  31. Truitt E, Thompson R, Blazey-Martin D, NiSai D, Salem D. NiSai D, Salem D. Effect of the implementation of barcode technology and an electronic medication administration record on adverse drug events. Hosp Pharm. 2016;51(6):474–83. doi:.https://doi.org/10.1310/hpj5106-474
  32. Cochran GL, Jones KJ, Brockman J, Skinner A, Hicks RW. Errors prevented by and associated with bar-code medication administration systems. Jt Comm J Qual Patient Saf. 2007;33(5):293–301, 245. doi:.https://doi.org/10.1016/S1553-7250(07)33034-1
  33. Giuliano KK. IV smart pumps: the impact of a simplified user interface on clinical use. Biomed Instrum Technol. 2015;49(s4):13–21. doi:.https://doi.org/10.2345/0899-8205-49.s4.13
  34. Schneider PJ, Pedersen CA, Scheckelhoff DJ. ASHP national survey of pharmacy practice in hospital settings: Dispensing and administration-2017. Am J Health Syst Pharm. 2018;75(16):1203–26. doi:.https://doi.org/10.2146/ajhp180151
  35. Franklin BD. ‘Smart’ intravenous pumps: how smart are they? BMJ Qual Saf. 2017;26(2):93–4. doi:.https://doi.org/10.1136/bmjqs-2016-005302
  36. Schnock KO, Dykes PC, Albert J, Ariosto D, Call R, Cameron C, et al. The frequency of intravenous medication administration errors related to smart infusion pumps: a multihospital observational study. BMJ Qual Saf. 2017;26(2):131–40. doi:.https://doi.org/10.1136/bmjqs-2015-004465
  37. Melton KR, Timmons K, Walsh KE, Meinzen-Derr JK, Kirkendall E. Smart pumps improve medication safety but increase alert burden in neonatal care. BMC Med Inform Decis Mak. 2019;19(1):213. doi:.https://doi.org/10.1186/s12911-019-0945-2
  38. American Academy of Pediatrics Committee on Drugs, American Academy of Pediatrics Committee on Hospital Care. Prevention of medication errors in the pediatric inpatient setting. Pediatrics. 2003;112(2):431–6. doi:.https://doi.org/10.1542/peds.112.2.431
  39. Rinke ML, Bundy DG, Velasquez CA, Rao S, Zerhouni Y, Lobner K, et al. Interventions to reduce pediatric medication errors: a systematic review. Pediatrics. 2014;134(2):338–60. doi:.https://doi.org/10.1542/peds.2013-3531
  40. Kaufmann J, Laschat M, Wappler F. Medication errors in pediatric emergencies: a systematic analysis. Dtsch Arztebl Int. 2012;109(38):609–16. doi:.https://doi.org/10.3238/arztebl.2012.0609
  41. Flannery AH, Parli SE. Medication errors in cardiopulmonary arrest and code-related situations. Am J Crit Care. 2016;25(1):12–20. doi:.https://doi.org/10.4037/ajcc2016190
  42. Gonzales K. Medication administration errors and the pediatric population: a systematic search of the literature. J Pediatr Nurs. 2010;25(6):555–65. doi:.https://doi.org/10.1016/j.pedn.2010.04.002
  43. Kearns GL, Abdel-Rahman SM, Alander SW, Blowey DL, Leeder JS, Kauffman RE. Developmental pharmacology--drug disposition, action, and therapy in infants and children. N Engl J Med. 2003;349(12):1157–67. doi:.https://doi.org/10.1056/NEJMra035092
  44. Manrique-Rodríguez S, Sánchez-Galindo A, Fernández-Llamazares CM, López-Herce J, Rodríguez-Gómez M, Echarri-Martínez L, et al. Preparation of intravenous drug administration guidelines for a pediatric intensive care unit. J Infus Nurs. 2014;37(1):35–43. doi:.https://doi.org/10.1097/NAN.0000000000000019
  45. Hoyle JD, Jr, Davis AT, Putman KK, Trytko JA, Fales WD. Medication dosing errors in pediatric patients treated by emergency medical services. Prehosp Emerg Care. 2012;16(1):59–66. doi:.https://doi.org/10.3109/10903127.2011.614043
  46. Kämäräinen A. Out-of-hospital cardiac arrests in children. J Emerg Trauma Shock. 2010;3(3):273–6. doi:.https://doi.org/10.4103/0974-2700.66531
  47. Porter E, Barcega B, Kim TY. Analysis of medication errors in simulated pediatric resuscitation by residents. West J Emerg Med. 2014;15(4):486–90. doi:.https://doi.org/10.5811/westjem.2014.2.17922
  48. Lehmann CU, Kim GR, Gujral R, Veltri MA, Clark JS, Miller MR. Decreasing errors in pediatric continuous intravenous infusions. Pediatr Crit Care Med. 2006;7(3):225–30. doi:.https://doi.org/10.1097/01.PCC.0000216415.12120.FF
  49. Hoyle JD, Jr, Crowe RP, Bentley MA, Beltran G, Fales W. Pediatric prehospital medication dosing errors: a national survey of paramedics. Prehosp Emerg Care. 2017;21(2):185–91. doi:.https://doi.org/10.1080/10903127.2016.1227001
  50. Cottrell EK, O’Brien K, Curry M, Meckler GD, Engle PP, Jui J, et al. Understanding safety in prehospital emergency medical services for children. Prehosp Emerg Care. 2014;18(3):350–8. doi:.https://doi.org/10.3109/10903127.2013.869640
  51. Kaji AH, Gausche-Hill M, Conrad H, Young KD, Koenig WJ, Dorsey E, et al. Emergency medical services system changes reduce pediatric epinephrine dosing errors in the prehospital setting. Pediatrics. 2006;118(4):1493–500. doi:.https://doi.org/10.1542/peds.2006-0854
  52. Su E, Schmidt TA, Mann NC, Zechnich AD. A randomized controlled trial to assess decay in acquired knowledge among paramedics completing a pediatric resuscitation course. Acad Emerg Med. 2000;7(7):779–86. doi:.https://doi.org/10.1111/j.1553-2712.2000.tb02270.x
  53. Shah MN, Cushman JT, Davis CO, Bazarian JJ, Auinger P, Friedman B. The epidemiology of emergency medical services use by children: an analysis of the National Hospital Ambulatory Medical Care Survey. Prehosp Emerg Care. 2008;12(3):269–76. doi:.https://doi.org/10.1080/10903120802100167
  54. Winburn AS, Brixey JJ, Langabeer J, 2nd, Champagne-Langabeer T. A systematic review of prehospital telehealth utilization. J Telemed Telecare. 2018;24(7):473–81. doi:.https://doi.org/10.1177/1357633X17713140
  55. Sibson L. The use of telemedicine technology to support in pre-hospital patient care. Journal of Paramedic Practice. 2014;6(7):344–53. doi:.https://doi.org/10.12968/jpar.2014.6.7.344
  56. Kim H, Kim S-W, Park E, Kim JH, Chang H. The role of fifth-generation mobile technology in prehospital emergency care: An opportunity to support paramedics. Health Policy Technol. 2020;9(1):109–14. doi:.https://doi.org/10.1016/j.hlpt.2020.01.002
  57. Almadania B, Bin-Yahyaa M, Shakshukib EM. E-AMBULANCE: Real-time integration platform for heterogeneous medical telemetry system. The 5th International Conference on Current and Future Trends of Information and Communication Technologies in Healthcare (ICTH 2015) 2015.
  58. Foltin GL, Richmond N, Treiber M, Skomorowsky A, Galea S, Vlahov D, et al. Pediatric prehospital evaluation of NYC cardiac arrest survival (PHENYCS). Pediatr Emerg Care. 2012;28(9):864–8. doi:.https://doi.org/10.1097/PEC.0b013e3182675e70
  59. Fukuda T, Kondo Y, Hayashida K, Sekiguchi H, Kukita I. Time to epinephrine and survival after paediatric out-of-hospital cardiac arrest. Eur Heart J Cardiovasc Pharmacother. 2018;4(3):144–51. doi:.https://doi.org/10.1093/ehjcvp/pvx023
  60. Hansen M, Schmicker RH, Newgard CD, Grunau B, Scheuermeyer F, Cheskes S, et al.; Resuscitation Outcomes Consortium Investigators. Time to epinephrine administration and survival from nonshockable out-of-hospital cardiac arrest among children and adults. Circulation. 2018;137(19):2032–40. doi:.https://doi.org/10.1161/CIRCULATIONAHA.117.033067
  61. Rittenberger JC, Bost JE, Menegazzi JJ. Time to give the first medication during resuscitation in out-of-hospital cardiac arrest. Resuscitation. 2006;70(2):201–6. doi:.https://doi.org/10.1016/j.resuscitation.2005.12.006
  62. Matos RI, Watson RS, Nadkarni VM, Huang HH, Berg RA, Meaney PA, et al.; American Heart Association’s Get With The Guidelines–Resuscitation (Formerly the National Registry of Cardiopulmonary Resuscitation) Investigators. Duration of cardiopulmonary resuscitation and illness category impact survival and neurologic outcomes for in-hospital pediatric cardiac arrests. Circulation. 2013;127(4):442–51. doi:.https://doi.org/10.1161/CIRCULATIONAHA.112.125625
  63. Misasi P, Keebler JR. Medication safety in emergency medical services: approaching an evidence-based method of verification to reduce errors. Ther Adv Drug Saf. 2019;10:2042098618821916. doi:.https://doi.org/10.1177/2042098618821916
  64. Walker D, Moloney C, SueSee B, Sharples R. Contributing factors that influence medication errors in the prehospital paramedic environment: a mixed-method systematic review protocol. BMJ Open. 2019;9(12):e034094. doi:.https://doi.org/10.1136/bmjopen-2019-034094
  65. Cushman JT, Fairbanks RJ, O’Gara KG, Crittenden CN, Pennington EC, Wilson MA, et al. Ambulance personnel perceptions of near misses and adverse events in pediatric patients. Prehosp Emerg Care. 2010;14(4):477–84. doi:.https://doi.org/10.3109/10903127.2010.497901
  66. LeBlanc VR, MacDonald RD, McArthur B, King K, Lepine T. Paramedic performance in calculating drug dosages following stressful scenarios in a human patient simulator. Prehosp Emerg Care. 2005;9(4):439–44. doi:.https://doi.org/10.1080/10903120500255255
  67. Lammers R, Byrwa M, Fales W. Root causes of errors in a simulated prehospital pediatric emergency. Acad Emerg Med. 2012;19(1):37–47. doi:.https://doi.org/10.1111/j.1553-2712.2011.01252.x
  68. Wells M, Goldstein LN, Bentley A, Basnett S, Monteith I. The accuracy of the Broselow tape as a weight estimation tool and a drug-dosing guide - A systematic review and meta-analysis. Resuscitation. 2017;121:9–33. doi:.https://doi.org/10.1016/j.resuscitation.2017.09.026
  69. Clifford GD. E-health in low to middle income countries. J Med Eng Technol. 2016;40(7-8):336–41. doi:.https://doi.org/10.1080/03091902.2016.1256081
  70. Ochalek J, Lomas J, Claxton K. Estimating health opportunity costs in low-income and middle-income countries: a novel approach and evidence from cross-country data. BMJ Glob Health. 2018;3(6):e000964. doi:.https://doi.org/10.1136/bmjgh-2018-000964
  71. World Telecommunication ITU. ITU Statistics. Individuals using the Internet, by level of development. 2020 [2020.04.04]. Available from: https://www.itu.int/en/ITU-D/Statistics/Pages/stat/default.aspx.
  72. Wallis L, Blessing P, Dalwai M, Shin SD. Integrating mHealth at point of care in low- and middle-income settings: the system perspective. Glob Health Action. 2017;10(sup3, suppl_3):1327686. doi:.https://doi.org/10.1080/16549716.2017.1327686
  73. Bezuidenhout L, Chakauya E. Hidden concerns of sharing research data by low/middle-income country scientists. Glob Bioet. 2018;29(1):39–54. doi:.https://doi.org/10.1080/11287462.2018.1441780
  74. Langer A, Díaz-Olavarrieta C, Berdichevsky K, Villar J. Why is research from developing countries underrepresented in international health literature, and what can be done about it? Bull World Health Organ. 2004;82(10):802–3.
  75. Acheampong F, Anto BP, Koffuor GA. Medication safety strategies in hospitals--a systematic review. Int J Risk Saf Med. 2014;26(3):117–31. doi:.https://doi.org/10.3233/JRS-140623
  76. Berdot S, Roudot M, Schramm C, Katsahian S, Durieux P, Sabatier B. Interventions to reduce nurses’ medication administration errors in inpatient settings: A systematic review and meta-analysis. Int J Nurs Stud. 2016;53:342–50. doi:.https://doi.org/10.1016/j.ijnurstu.2015.08.012
  77. Luten R, Wears RL, Broselow J, Croskerry P, Joseph MM, Frush K. Managing the unique size-related issues of pediatric resuscitation: reducing cognitive load with resuscitation aids. Acad Emerg Med. 2002;9(8):840–7. doi:.https://doi.org/10.1197/aemj.9.8.840
  78. Metelmann B, Metelmann C, Schuffert L, Hahnenkamp K, Brinkrolf P. Medical correctness and user friendliness of available apps for cardiopulmonary resuscitation: systematic search combined with guideline adherence and usability evaluation. JMIR Mhealth Uhealth. 2018;6(11):e190. doi:.https://doi.org/10.2196/mhealth.9651
  79. Lauridsen KG, Nadkarni VM, Berg RA. Man and machine: can apps resuscitate medical performance? Lancet Child Adolesc Health. 2019;3(5):282–3. doi:.https://doi.org/10.1016/S2352-4642(19)30032-X
  80. Baumann D, Dibbern N, Sehner S, Zöllner C, Reip W, Kubitz JC. Validation of a mobile app for reducing errors of administration of medications in an emergency. J Clin Monit Comput. 2019;33(3):531–9. doi:.https://doi.org/10.1007/s10877-018-0187-3
  81. Segal JB, Arevalo JB, Franke MF, Palazuelos D. Reducing dosing errors and increasing clinical efficiency in Guatemala: first report of a novel mHealth medication dosing app in a developing country. BMJ Innov. 2015;1(3):111–6. doi:.https://doi.org/10.1136/bmjinnov-2015-000051
  82. Cummings P. Carryover bias in crossover trials. Arch Pediatr Adolesc Med. 2010;164(8):703–5. doi:.https://doi.org/10.1001/archpediatrics.2010.126
  83. Hagberg H, Siebert J, Gervaix A, Daehne P, Lovis C, Manzano S, et al. Improving drugs administration safety in pediatric resuscitation using mobile technology. Stud Health Technol Inform. 2016;225:656–7.
  84. Siebert JN, Ehrler F, Combescure C, Lovis C, Haddad K, Hugon F, et al.; PedAMINES Trial Group. A mobile device application to reduce medication errors and time to drug delivery during simulated paediatric cardiopulmonary resuscitation: a multicentre, randomised, controlled, crossover trial. Lancet Child Adolesc Health. 2019;3(5):303–11. doi:.https://doi.org/10.1016/S2352-4642(19)30003-3
  85. Cheng A, Kessler D, Mackinnon R, Chang TP, Nadkarni VM, Hunt EA, et al.; International Network for Simulation-based Pediatric Innovation, Research, and Education (INSPIRE) Reporting Guidelines Investigators. Reporting guidelines for health care simulation research: extensions to the CONSORT and STROBE statements. Simul Healthc. 2016;11(4):238–48. doi:.https://doi.org/10.1097/SIH.0000000000000150
  86. Siebert JN, Ehrler F, Combescure C, Lacroix L, Haddad K, Sanchez O, et al. A mobile device app to reduce time to drug delivery and medication errors during simulated pediatric cardiopulmonary resuscitation: a randomized controlled trial. J Med Internet Res. 2017;19(2):e31. doi:.https://doi.org/10.2196/jmir.7005
  87. Cheng A, Auerbach M, Hunt EA, Chang TP, Pusic M, Nadkarni V, et al. Designing and conducting simulation-based research. Pediatrics. 2014;133(6):1091–101. doi:.https://doi.org/10.1542/peds.2013-3267
  88. Siebert JN, Bloudeau L, Ehrler F, Combescure C, Haddad K, Hugon F, et al. A mobile device app to reduce prehospital medication errors and time to drug preparation and delivery by emergency medical services during simulated pediatric cardiopulmonary resuscitation: study protocol of a multicenter, prospective, randomized controlled trial. Trials. 2019;20(1):634. doi:.https://doi.org/10.1186/s13063-019-3726-4