Reducing Medication Errors and Time to Drugs Delivery During Pediatric Cardiopulmonary Resuscitation: a Multicenter RCT
Reducing Medication Errors and Time to Drugs Delivery During Pediatric Cardiopulmonary Resuscitation: a Multicenter RCT
The investigators recruit nurses working in 5 swiss Pediatric Emergency Departments or
 divisions to prepare continuous infusions of vasoactive drugs during a simulation-based
 pediatric CPR cardiac arrest scenario. According to randomization, nurses will have to
 prepare and deliver vasoactive drugs following their current conventional methods or by the
 aim of a mobile tablet application called PedAMINES™. PedAMINES™ is designed to support them
 step-by-step from order to delivery of these drugs.

 1. Primary outcome will be to measure in each allocation group the number of medication
 dosage errors committed during each drug preparation sequence until injection.

 2. Secondary outcome will be to measure the time to drug preparation (TDP) and time to drug
 delivery (TDD).
During pediatric cardiopulmonary resuscitation (CPR), vasoactive drug preparation for
 continuous infusion is both complex and time-consuming, placing children at higher risk than
 adults for medication errors. It is well established that CPR duration is inversely
 correlated to survival, decreasing linearly by 2.1 % per minute, and to decreased risk of
 neurological sequelae [1].

 In this study, the investigators recruit nurses working in 5 swiss Pediatric Emergency
 Departments or divisions to prepare continuous infusions of vasoactive drugs during a
 simulation-based pediatric CPR cardiac arrest scenario with a high-fidelity manikin (Laerdal
 SimJunior™). The scenario will take place in the shock room to increase realism.

 According to randomization with a 1:1 allocation ratio, nurses will have to prepare and
 deliver vasoactive drugs following their current conventional methods or by the aim of a
 mobile tablet application called PedAMINES™ (Pediatric Accurate Medication In Emergency
 Situations). PedAMINES™ is designed to support nurses step-by-step from order to delivery of
 a wide range of drugs, especially those requiring continuous infusion. PedAMINES™ has already
 been shown in a single-center simulation-based study to reduce time to vasoactive drug
 preparation, to delivery and the rate of medication errors [2].

 On the day of participation, after obtaining nurse's written informed consent and
 randomization, nurses will receive a standardized 5-minute training session on how to use the
 app. Then, the nurses will be asked to perform a standardized 15-minute highly realistic CPR
 scenario, including post-return of spontaneous circulation (ROSC). After epinephrine-induced
 ROSC, nurses will be asked to first prepare a continuous infusion of dopamine, using either
 PedAMINES™ or a conventional method, and then a continuous infusion of norepinephrine by
 crossing the procedure. Moreover, 2 questionnaires will be given before and after the
 scenario to ask the nurses about their demographics data, perceived stress and degree of
 satisfaction.

 1. Primary outcome will be to measure in each allocation group the number of medication
 dosage errors committed during each drug preparation sequence until injection.

 2. Secondary outcome will be to measure the time to drug preparation (TDP) and time to drug
 delivery (TDD).

 All the actions (i.e. primary and secondary outcomes) performed by the nurses during the
 scenario will be automatically recorded and stored by the responsive simulator detectors, the
 application and by several video cameras. To avoid assessment bias, two evaluators will then
 independently review these video recordings. In case of disagreement, a third independent
 evaluator will help reach a consensus.

 We aim to determine whether the use of PedAMINES™ might improve the management of acute
 life-threatening conditions by quickly delivering expertise in vasoactive drugs
 administration in other hospitals in Switzerland, even in non-university hospitals where
 nurses (and physicians) are either little or not exposed to pediatric CPRs. We hypothesize
 that PedAMINES™ might primary reduce medication errors, and secondary reduce delays to drugs
 preparation and delivery independently of the existing conventional preparation methods or
 nurses' skills.
Inclusion Criteria:

 -  To be nurse certified

 -  To know how to prepare intravenous drugs injection.

 -  To have previously completed the 5-minute introductory course to the use of PedAMINES
 dispensed by the investigators of the study.

 -  Participation agreement

 Exclusion Criteria:

 -  To have at any time undergone a previous experiment with a cognitive numeric device
 aimed to help vasoactive drugs preparation.

 -  To have not undergone the 5-minute introductory course to the use of PedAMINES.