PC1009: Improving Pediatric Weight Measurements in the Emergency Department: A Quality Improvement Project

Purpose/Objectives: Medication error rates are three times more common in children than in adults, and higher rates occur in the emergency department (ED). For children, the correct medication dose is determined through obtaining an accurate weight for each patient. Approximately 25% of medication errors in children are due to confusion between pounds and kilograms, and the National Pediatric Readiness Project (NPRP) recommends all EDs obtain pediatric weights in kilograms only as part of standard practice.

The aim of this project was to increase the proportion of pediatric weights recorded in kilograms only at general, community, and critical access EDs.

Design/Methods: This is a multisite, prospective quality improvement (QI) project deployed within the Pediatric Readiness Quality Collaborative. Collaborative leadership and subject matter experts provided educational sessions to all participating sites that included instruction on QI core principles, intervention strategies, and specific tools to design quality initiatives. After this targeted intervention, each site developed individual improvement strategies, obtained baseline data, and progressed at their own pace through Plan Do Study Act (PDSA) cycle(s). The primary outcome measure was the proportion of children with weights recorded in kilograms only, pounds only, or both kilograms and pounds. The secondary outcome measure was the proportion of observed medication dosing errors. Using the patient’s recorded weight, we defined medication dosing errors as greater than ±20% of the standard medication dose. We analyzed both proportions of weights recorded in kilograms only and proportions of dosing errors with univariate chi-square testing.

Results: A total of 38 EDs from 8 states participated in this QI project. Table 1 presents the demographics of participating sites. Table 2 compares patient demographics in baseline and PDSA cycles. Collectively, participating EDs improved the proportion of children weighed in kilograms only from a baseline of 81.1% to 97.6% (p < 0.001). The improvement was significant across all age groups. We observed an overall medication dosing error rate of 18.7% but no change in medication dosing error rates between baseline and PDSA cycles (17.6% vs 19.8%, p=0.527).

Conclusion/Discussion: We demonstrate that a large cohort of hospitals comprised mainly of general, community, and critical access EDs with lower pediatric volumes can significantly increase the proportion of children whose weights are only recorded in kilograms when provided with education, intervention strategies, and tools to develop and implement a QI project. We did not observe a corresponding decrease in medication dosing errors likely due to factors not assessed by this project. Further QI work may be informed by this project to evaluate factors that more effectively reduce medication dosing errors in children.