Background Paediatric emergencies can be challenging, time critical and often stressful situations. Recall of protocols and treatments from memory, including correct drug dosages, is fraught by human error. Although paediatric guidelines are available in printed or web-based format, quite frequently these are not available immediately. Consequently, there can be treatment delays, sub-optimal protocol adherence and drug errors, leading to patient harm. Studies have shown that in a simulated environment, the accuracy of emergency drug dosing is <20% without using a dosing guide; this was improved to 47% by providing an aid.¹

Mobile applications commonly used in emergency departments has been showed to reduce the drug preparation time and time to delivery.² But this is dependent on internet signal and availability or restrictions placed by hospitals.³ The use of convenient portable cards has been useful in both paediatric and adult medicine settings ^4,5,6.

Objectives

• Develop 6 lanyard flashcards featuring common paediatric life support protocols and emergency drug calculations.

• Describe clinicians’ views on the potential benefit of using flashcards for accessing paediatric life support guidelines quickly and accurately.

Methods A pre implementation survey was conducted in the paediatric emergency department. Using a Likert scale, staff ranked emergency topics in order of importance for inclusion on the flashcards.

Cards were designed based on these suggestions, and approved by senior paediatricians and the pharmacy team. These featured emergency algorithms, common emergency drug dosages in cardiac arrests, endotracheal intubation and maintaining cardiovascular support, age-based vital sign ranges and WETFLAG calculations. These flashcards could be worn conveniently on lanyards together with identity badges. These were distributed within the paediatric emergency department and wards to act as aide-memoire cards during emergencies.

A post implementation survey was completed 1 month after distribution.

Both surveys were completed by a range of junior and senior doctors and paediatric nurses.

Results The pre-implementation survey (responders=36) showed that staff accessed local guidelines from a variety of sources: memory (n=10), the internet (n=7), the trust intranet (n=21), printed booklet guidelines (n=12), other (n=6); with many using more than one of these.

Prior to introducing the flashcards, only 9% of participants (n=3) were able to locate guidelines in <1 minute, with a further 63% (n=22) locating this information in <3 minutes. The remaining 28% (n=10) took >3 minutes.

After implementation of the flashcards 69% of participants (n=39) were able to access guidelines in <1 minute, and 100% were able to access this information in < 3 minutes.

Conclusions The flashcards improved the time to access paediatric life support guidelines, with good acceptance across a range of doctors and nurses in the emergency department and wards. Following this project these flashcards have been distributed to non-emergency staff redeployed during the Covid-19 pandemic.