Can paramedics’ accurately perform drug calculations?
Date First Published:
February 20, 2008
Last Updated:
January 29, 2009
Report by:
Kathryn J Eastwood, Masters Student (Monash University)
Search checked by:
Malcolm J Boyle, Monash University
Three-Part Question:
Are [Paramedics'][able to perform drug calculations] with [100% accuracy]
Clinical Scenario:
Paramedics may be exposed to incidents in uncontrolled environments, managing potentially critically ill patients, other people, and other emergency services. In the presence of these factors, can paramedics still conduct drug calculations with a high degree of accuracy?
Search Strategy:
Medline: 1950 to end of November 2007, CINHAL: 1982 to end of November 2007, EMBASE: 1980 to end of November 2007.<br><br>Medline:(emergency medical service$.sh OR emergency medical technic$.sh OR ambulance$.sh OR air ambulance$.sh OR military medicine.sh OR emergency treatment.sh OR emergency medicine.sh OR first aid.sh) AND (pre-hospital.ti OR pre-hospital.tw OR prehospital.ti OR out of hospital.tw OR out-of-hospital.tw OR (ambulance$ or air ambulance$).tw OR paramedic$.ti,tw) AND (drug calculation.tw OR medication calculation.tw OR maths.tw OR mathematics.tw OR students.tw OR nursing.tw OR maths skills.tw OR medication safety.tw OR drug administration errors.tw OR nurse education.tw OR numeracy skills.tw OR student nurses.tw OR dosage calculations.tw OR medication administration.tw OR pharmacological skills.tw OR problem solving.tw OR problem-solving.tw OR calculation.tw OR medication-related errors.tw OR medication calculation skills.tw OR calculation methods.tw OR mathematical skills.tw OR drug calculation skills.tw OR conceptualizing drug calculations.tw OR drug dosages.tw OR mathematical anxiety.tw OR math anxiety.tw OR mathematical comprehension.tw) LIMIT to (Humans AND English)<br><br>CINHAL:(emergency medical service$.sh OR emergency medical technic$.sh OR ambulance$.sh OR military medicine.sh OR emergency medicine.sh OR emergency care.sh OR emergency patients.sh OR prehospital care.sh OR transportation of patients.sh OR first aid.sh OR mass casuality incident.sh) AND (pre-hospital.ti OR pre-hospital.tw OR prehospital.ti OR out of hospital.tw OR out-of-hospital.tw OR (ambulance$ or air ambulance$).tw OR paramedic$.ti,tw) AND (drug calculation.tw OR medication calculation.tw OR maths.tw OR mathematics.tw OR students.tw OR nursing.tw OR maths skills.tw OR medication safety.tw OR drug administration errors.tw OR nurse education.tw OR numeracy skills.tw OR student nurses.tw OR dosage calculations.tw OR medication administration.tw OR pharmacological skills.tw OR problem solving.tw OR problem-solving.tw OR calculation.tw OR medication-related errors.tw OR medication calculation skills.tw OR calculation methods.tw OR mathematical skills.tw OR drug calculation skills.tw OR conceptualizing drug calculations.tw OR drug dosages.tw OR mathematical anxiety.tw OR math anxiety.tw OR mathematical comprehension.tw) LIMIT to (Humans AND English)<br><br>EMBASE:(ambulance*:de OR 'prehospital care':de OR 'emergency health service':de OR 'paramedical personnel':de OR 'military medicine':de OR 'first aid':de OR 'emergency medicine':de OR 'emergency treatment':de OR 'air ambulance':de OR prehospital:de OR paramedic*:ab,ti OR ambulance*:ab,ti OR 'out-of-hospital':ab,ti OR 'out of hospital':ab,ti OR ems:ab,ti OR emt:ab,ti OR 'emergency services':ab,ti OR 'emergency medical services':ab,ti OR 'emergency technicians':ab,ti OR 'emergency practitioner':ab,ti OR 'emergency dispatch':ab,ti OR 'emergency despatch':ab,ti OR 'first responder':ab,ti OR 'emergency rescue':ab,ti OR 'emergency resus':ab,ti AND ('drug calculation':ab,ti OR 'medication calculation':ab,ti OR maths:ab,ti OR mathematics:ab,ti OR students:ab,ti OR nursing:ab,ti OR 'maths skills':ab,ti OR 'medication safety':ab,ti OR 'drug administration errors':ab,ti OR 'nurse education':ab,ti OR 'numeracy skills':ab,ti OR 'student nurses':ab,ti OR 'dosage calculations':ab,ti OR 'medication administration':ab,ti OR 'pharmacological skills':ab,ti OR 'problem solving':ab,ti OR 'problem-solving':ab,ti OR calculation:ab,ti OR 'medication-related errors':ab,ti OR 'medication calculation skills':ab,ti OR 'calculation methods':ab,ti OR 'mathematical skills':ab,ti OR 'drug calculation skills':ab,ti OR 'conceptualizing drug calculations':ab,ti OR 'drug dosages':ab,ti OR 'mathematical anxiety':ab,ti OR 'math anxiety':ab,ti OR 'mathematical comprehension':ab,ti) LIMIT to (Humans AND English).
Outcome:
A total of 1,266 articles were located in the three databases, of which two were suitable for inclusion.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Medication calculation skills of practicing paramedics Hubble MW, Paschal KR, Sanders TA. 2000, U.S.A. | 109 Qualified Paramedics from North Carolina, U.S.A. | Descriptive | Drug calculation accuracy on a 10-item questionnaire | Mean test score was 51.4% | Small numbers, sample taken from North Carolina only. Paramedics reported that they infrequently used calculations in practice. |
| Paramedic performance in calculating drug dosages following stressful scenarios in a human patient simulator LeBlanc VR, MacDonald RD, McArthur B, King K, Lepine T 2005, Canada | 30 qualified flight paramedics of varying qualification levels from Canada | Descriptive | Drug calculation accuracy in high (post-simulated) patient and low-stress (classroom) situations, | 43.1% Correct in high stress situations, 57.9% in low stress situations | Small numbers, high-stress drug calculations were conducted after the stressor had been applied (not during. Single service sample. |
Author Commentary:
These findings are supported in the nursing (see Faddis, Harne-Britner et al and Santamaria et al) and medical (see Kozer et al) literature and confirm that a majority of healthcare providers are not able to calculate drug dosages accurately.
Bottom Line:
Even when paramedics are not under on-the-job pressure their ability to accurately perform drug calculations is poor.
References:
- Hubble MW, Paschal KR, Sanders TA.. Medication calculation skills of practicing paramedics
- LeBlanc VR, MacDonald RD, McArthur B, King K, Lepine T. Paramedic performance in calculating drug dosages following stressful scenarios in a human patient simulator
- Faddis MO. . Eliminating errors in medication.
- Harne-Britner S, Kreamer CL, Frownfelter P, et al.. Improving medication calculation skills of practicing nurses and senior nursing students: a pilot study.
- Santamaria N, Norris H, Clayton L, et al.. Drug calculation competencies of graduate nurses.
- Kozer E, Seto W, Verjee Z, et al.. Prospective observational study on the incidence of medication errors during simulated resuscitation in a paediatric emergency department.