Document Type

Capstone Experience

Graduation Date

12-2018

Degree Name

Master of Public Health

Department

Biostatistics

Abstract

Goal: The goal of this project was to determine if the implementation of the Handtevy app reduced medication error rates on calls run by the San Antonio Fire Department in the pediatric population with a diagnosis involving pain management or seizure. Background: Prior to the implementation of the Handtevy app, first responders used a tool called the Broselow tape to estimate a child’s weight and to determine the appropriate medication dose. Run reports were analyzed prior to the implementation of the Handtevy pediatric standard to determine medication error rates for Fentanyl and Versed in pediatric patients 13 years or younger. Run reports were also analyzed after the implementation of the Handtevy app to determine medication error rates for Fentanyl and Versed in pediatric patients 13 years or younger. Medication error rates were compared pre and post Handtevy app implementation to determine if there was a difference. Methods: This was a retrospective study comparing a 3-month time period prior to the deployment of the Handtevy pediatric standard with a 3-month time period following full implementation of Handtevy. The dates of data being used were calls run from January 1, 2016 through March 31, 2016 and January 1, 2018 through March 31, 2018. 2017 was the implementation period. A call was defined as any response where the San Antonio Fire Department treated a pediatric patient for pain or seizure. No intervention was implemented in this study and no in-person recruitment of subjects was needed. SAFD electronic medical records were collected from the Southwest Texas Regional Advisory Council (STRAC) database. Data extraction begun by selecting all SAFD EMS run reports in the STRAC region involving pain management or a seizure within the time period of January 1, 2016 through March 31, 2016 and January 1, 2018 through March 31, 2018. Eligibility criteria included: children 13 years or younger treated by the San Antonio Fire Department. Children not treated for pain or seizure or children over the age of 13 and adults were excluded from data collection and analysis. Impact: Cumulative medication error rates decreased from 83% in Q1 2016 to 44.4% in Q1 2018 and medication usage increased by 58% from 2016 to 2018. This could be due to the increase in patients seen in 2018 versus 2016. This study revealed a disproportionate use of narcotics to reported pain in children and in turn may promote more frequent use of narcotics in children with the use of the Handtevy app in the future. The results of this study could also potentially encourage the shift from using the Broselow Tape for weight estimation leading to medication dosage calculations to using only the Handtevy app to provide predetermined medication dosages.

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