Project Summary
The objective of this project is to develop a safe and effective dynamic cognitive aid application for use
through a head-mounted display (HMD), to reduce error rates associated with pediatric medication
administration (PMA) by emergency medical services (EMS). This objective will be achieved by examining
characteristics associated with PMA, using a design thinking process to develop a prototype application,
examining usability of the prototype, and testing the safety and efficacy in a randomized controlled trial.
Errors associated with PMA in EMS are alarmingly high. Numerous studies have shown that there is a 31%
error rate across all drugs administered to children by EMS. Medications such as midazolam and fentanyl have
even higher rates at 61% and 65%, respectfully, with many being 10-fold errors. Sadly, previous strategies
have had little impact on reducing error rates below 31%. System changes have failed due to inconsistencies
in EMS systems, and challenges associated with medication shortages. Previously developed cognitive aids
have fallen short often due to the fact they generally act as simple reference tools and do not address all
causes of error associated with PMA. As a result, we are proposing the most comprehensive design process
ever taken to combat this issue, utilizing advanced technology, to implement a dynamic cognitive aid to help
providers improve dosing accuracy during PMA.
We hypothesize that PMA errors in EMS will be significantly reduced by this application due to the
comprehensive and rigorous design thinking process we will utilize followed by a randomized controlled trial to
test safety and efficacy. Our interdisciplinary team will combine the fields of pediatric emergency medicine,
EMS, engineering, computer science and user interface/user experience to address this issue with the support
and effort of two medical schools in Michigan. In SA1 we will develop a prototype application. This will begin
with identifying user and contextual information associated with PMA, and examine failure modes, root causes,
and a task analysis of the procedure. We will then proceed into a comprehensive design thinking process to
develop the application. During this process we will also create a desktop program that will allow EMS agency
administrators to add new medications to the HMD application. In SA2, we will examine usability of the HMD
application and associated desktop program in a simulation-based environment with a sample of end users,
examining task duration, cognitive load and error rates and make any necessary refinements. In SA3, we will
test the HMD application in a simulation-based randomized controlled trial to examine its safety and efficacy for
use in EMS. This will result in a safe and effective tool to mitigate this alarming issue in the vulnerable EMS
pediatric population.
