On-demand computerised decision support in paediatric emergency medication administration

Medication errors are common and contribute significantly to avoidable morbidity and mortality. These errors are more common in paediatrics than in adult medicine and yet more common in emergencies than in non-urgent scenarios. Emergency medication use in paediatrics is a complex process, often performed by a multidisciplinary team. This practise spans paediatric emergency weight estimation, medication ordering and the preparation, labelling and finally administration of drugs to critically ill children. Discrepancies during any one of these stages may be the cause of a medication error. This thesis describes the feasibility testing and iterative development of On-Demand Computerised Decision Support (ODCDSS), a digital medication safety system designed to support emergency doctors and nurses at all stages of medication use during paediatric resuscitation. This thesis decouples paediatric weight estimation and medication administration, with each being examined separately. First, opportunities to incorporate digitally-supported weight estimation methods into a comprehensive decision support system are explored. This includes efforts to improve well-established but inaccurate methods such as age-based weight estimation, and an exploration into whether emerging technologies such as three- dimensional imaging could bring greater accuracy than current methods. To validate the design rationale behind ODCDSS, simulated resuscitations are examined using a human factors approach. Human Reliability Analysis (HRA) is 2 used to show both that the incidence of medication error is dangerously high and that many errors are clinically significant, as well to identify the individual process steps that contribute to these errors. This thesis is the first to describe the design and development of ODCDSS. The effectiveness of this experimental prototype was tested in a simulated crossover study which determined that using ODCDSS significantly reduced the odds of a clinically significant medication error occurring. The use of ODCDSS, however, was not error free, and HRA was re-applied to determine precisely where the prototype system required design refinement.