Managers: Use color-coded forms in the ED

You already may use the Broselow/Luten Rainbow tape to calculate correct dosages for pediatric patients. Now there are discharge instructions and treatment sheets available to help ensure accurate dosing. (See sample, inserted in this issue.)

The products are being used in four North Carolina EDs: Northern Hospital of Surrey County, Womack Army Hospital at Fort Bragg, Bowman Gray School of Medicine-Baptist Hospital in Winston-Salem, and Duke University Medical Center in Durham.

At Duke’s ED, 25 physicians and 50 nurses were surveyed, and focus groups were conducted. "Their overall response was that the products were helpful to deliver age-appropriate information to kids and their families," reports Karen Frush, MD, FAAP, director of pediatric emergency medicine at Duke. "I think the system is such a great idea, and it has improved my practice. It helps me give better care to kids, and I am pediatric trained."

The color-coded materials will raise the general level of pediatric emergency care, according to James Broselow, MD, FACEP, who developed the products. "They will increase the efficiency of pediatric resuscitation while decreasing the general level of anxiety," he explains. "Hopefully, the discharge sheets will also help us better communicate information about pediatric dosing and injury prevention to the lay public."

Here are some of the benefits of the new color-coded products:

• Discharge instructions.

The discharge instructions may be more useful in small community EDs that treat a small number of pediatric patients, notes Frush. "We looked at it in an academic center with pediatric services, but the clinicians with the strongest positive reactions were the ones who spent less of their time working with children. It seems to be a very useful tool for people without pediatric experience."

Parents like the fact that the discharge instructions are age-specific, she says. "There are some things that have very specific differences for different ages. When you give parents a piece of paper that is color-coded, it’s more individualized care. They feel that this is my child you’re talking about, not just any patient.’"

• Acute treatment booklets.

Color-coded treatment booklets list the resusci tative doses and equipment seen most commonly in the ED. Using the treatment booklet requires a change in outlook, notes Frush. "This is not how we are trained. We base everything on weight and use formulas to calculate doses and determine equipment sizes."

Look at the doses suggested by the system and critically evaluate them, she advises. "Then you can use it with confidence and allow yourself to free up that part of your mind."

The treatment sheets helped providers to feel more confident in giving the correct dosages and equipment sizes, says Frush. "Having the equipment size already determined helped them to concentrate on resuscitating the child. It provides an organizational approach, so you can go through the protocols and don’t have to remember a number."

It’s best to use the printed dosage information with the Rainbow tape, she advises. There is dosage information on the tape, she says, "but once you lay it down to measure the child, the printing is very small and in different colors, so it’s hard to read." The information on the sheet is a clearer presentation of the material and easier to read. "That allows you to lay down the tape just to get the color."

Medication dosages are listed according to the child’s medical condition, such as seizure. "So you don’t have to look up a long list of alphabetized medications. Instead, you can go by the problem you’re dealing with," she says.

• Over-the-counter products.

Color-coded products for over-the-counter use also are being tested. Studies have shown that parents give incorrect dosages more than 50% of the time, but with color-coded syringes, parents gave correct dosages 95% of the time, Frush reports.

In the study, 75 parents who brought a child to the ED were given a sheet of paper that had a weight range, which indicated the color for the child based on weight. They were handed a syringe and asked to draw up a dose for the child. "The doses were incredibly consistent and accurate with what the indicated amount should be," says Frush.

Even non-English-speaking caregivers gave correct dosages, she notes. "When one Hispanic woman was given the acetaminophen and a syringe and told to draw up the dose, she commented that she liked color more than numbers or English."

James Broselow, MD, FACEP, 1315 Wessex Lane, Hickory, NC 28602. Telephone/fax: (828) 294-2815. E-mail: rainbow@twave.net.

Karen Frush, MD, FAAP, Director of Pediatric Emergency Medicine, Box 3096, Duke University Medical Center, Durham, NC 27710. Telephone: (919) 681-2246. Fax: (919) 681-7402. E-mail: frush002@ mc.duke.edu.

Todd KH, Deaton C, D’Adamo AP, et al. Ethnicity and analgesic practice. Ann Emerg Med 2000; 35: 11-16.