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American Academy of Pediatrics
Research Articles

A Cognitive Aid for Neonatal Epinephrine Dosing

Kate D. Brune, Varsha Bhatt-Mehta, Deborah M. Rooney, John T. Adams and Gary M. Weiner
Hospital Pediatrics November 2020, 10 (11) 986-991; DOI: https://doi.org/10.1542/hpeds.2020-000299
Kate D. Brune
aDepartment of Pediatrics, St Joseph Mercy Hospital, Ann Arbor, Michigan;
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Varsha Bhatt-Mehta
bDepartment of Clinical Pharmacy, College of Pharmacy and
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Deborah M. Rooney
cDepartment of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan;
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John T. Adams
dDepartment of Pediatrics, Ascension St John Children’s Hospital, Detroit, Michigan; and
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Gary M. Weiner
eDivision of Neonatal-Perinatal Medicine, Department of Pediatrics, Michigan Medicine, University of Michigan and C.S. Mott Children’s Hospital, Ann Arbor, Michigan
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Abstract

OBJECTIVES: Errors are common when preparing epinephrine for neonatal resuscitation. Epinephrine is available in two concentrations (1 mg/mL and 1 mg/10 mL) and requires weight-based calculations, which increases the risk of dosing errors. We developed a printed cognitive aid to assist with dose preparation. We hypothesized that the cognitive aid would result in a 25% difference in errors in preparing the dose of epinephrine during simulated neonatal resuscitation.

METHODS: Nurses (N = 100) in a large academic and community hospital were randomly assigned to calculate the intended dose and prepare epinephrine for neonatal resuscitation with or without the cognitive aid. Scenarios were video recorded and timed. Secondary outcomes included errors in the written intended dose, errors in choosing the correct epinephrine concentration, and time required to prepare the final dose. Proportions were compared by using Fisher’s exact test. Variables influencing dosing errors were investigated by using logistic regression.

RESULTS: Using the cognitive aid significantly decreased the proportion of doses prepared incorrectly (24% vs 50%; P = .01). The aid also decreased errors in choosing the correct epinephrine concentration (12% vs 44%; P < .001), but there was no difference in the written intended dose or the time to prepare the dose. Years of experience, self-perceived math comfort, and anxiety were not predictive of dosing errors.

CONCLUSIONS: A simple cognitive aid decreased epinephrine dosing errors during simulated neonatal resuscitation but did not improve efficiency. Despite the effectiveness of the cognitive aid, errors were not completely eliminated. This is a serious safety risk for newborns and requires additional interventions.

  • Copyright © 2020 by the American Academy of Pediatrics
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Hospital Pediatrics: 10 (11)
Hospital Pediatrics
Vol. 10, Issue 11
1 Nov 2020
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A Cognitive Aid for Neonatal Epinephrine Dosing
Kate D. Brune, Varsha Bhatt-Mehta, Deborah M. Rooney, John T. Adams, Gary M. Weiner
Hospital Pediatrics Nov 2020, 10 (11) 986-991; DOI: 10.1542/hpeds.2020-000299

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A Cognitive Aid for Neonatal Epinephrine Dosing
Kate D. Brune, Varsha Bhatt-Mehta, Deborah M. Rooney, John T. Adams, Gary M. Weiner
Hospital Pediatrics Nov 2020, 10 (11) 986-991; DOI: 10.1542/hpeds.2020-000299
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