Use color-coded tapes correctly or risk errors
In your ED, the color-coded Broselow Pediatric Emergency Tape, a length-based measuring tape that accurately estimates a child’s weight, is probably a familiar sight. But are you using the tape correctly?
Incorrect usages of the tape include measuring from the wrong end and failing to place the child’s heels on the tape, says Susan Hohenhaus, RN, project manager for EMS for Children at Duke University Medical Center in Durham, NC.
"Some ED nurses simply do not know how to position it or what the color zones indicate or are related to," she adds.
ED nurses sometimes place the tape upside down and measure from the wrong end, which results in an incorrect color zone, says Hohenhaus. "So, all medication dosages and equipment sizes would be wrong," she says.
For example, if the child is 8 kg and measures in the red zone, and the tape were used upside down, the nurse might measure the child in the yellow zone, which is for weights of 12-14 kg, resulting in too-large dosages, says Hohenhaus.
Even experienced ED practitioners have difficulty accurately estimating a child’s weight just by looking at them, says Paula J. Mialon, PharmD, BS, senior clinical pharmacist for the department of emergency medicine at Children’s Medical Center in Dallas. "This is one of the reasons there are so many dosing errors," she says.
Ten percent of 1,532 children treated in a pediatric ED had a medication error, according to a recent study, and dosage mistakes were the most common cause of the drug errors.1
Used correctly, the tape gives you accurate dosage information, says Mialon. "It contains dosages based by weight, so you just look at the tape section for that weight and the dose is right there," she says.
The tape is most useful for a patient who is otherwise unable to be weighed, such as trauma patients, seizing patients, unconscious patients, and combative patients, including tired toddlers, says Mialon.
"The tape provides a really close estimate that can be used for all emergent dosing and procedures until the patient is in a condition more conducive to being weighed," she explains.
To ensure you are using the color-coded tape correctly, do the following:
• Use the tape routinely for all pediatric patients.
The tape is most commonly used to obtain a child’s weight, but it also contains a wealth of other useful information, including correct equipment sizes and emergent medication doses, says Mialon.
Although the tape generally is used for acutely ill or injured patients, you can increase your comfort level and skill by using it for less acute patients, suggests Mialon. For example, the tape can be used to determine dosages for antibiotics, she says.
"A book available with the system contains a comprehensive listing of medications," she notes. "You just open the book to the page that corresponds with the child’s weight."
Likewise, you can use the tape to check equipment sizes when treatments are ordered, says Patricia Scott, RN, BSN, CEN, nurse leader for the ED at Martin Memorial Medical Center in Stuart, FL.
Use the tape to assign a color zone to all children younger than 12 years old, recommends Hohenhaus. "When obtaining vital signs, the child is measured with the tape so that the color actually becomes a vital sign," she explains.
Find innovative ways to do this that are fun for pediatric patients, says Hohenhaus. "For instance, you can paint a rainbow on the triage wall that correlates to the length of the color zones, and measure the child against it," she suggests.
• Make sure the tape is in good condition.
At Martin Memorial’s ED, the Broselow color-coded tape is laminated, says Scott. "This makes the tape easily visible, easily cleaned, and not likely to be misplaced or torn," she says. "If the tape is contaminated, it must be discarded since it is laminated paper."
• Practice using the tape.
There should be formal, standardized training in the use of the tape for all new ED nurses, recommends Hohenhaus. In addition, you should practice using the tape during mock resuscitation scenarios whenever possible, says Scott.
"When a child needing resuscitation arrives in your ED, you need to be comfortable with the tape and the selection of equipment and medications," she says.
• Work with pre-hospital providers in using the tape.
Pre-hospital reports may list the child’s color zone, notes Scott. "Verify the information, and care can continue in the ED with the same sizes of equipment and medication doses," she says.
Reference
1. Kozer E, Scolnik D, Macpherson A, et al. Variables associated with medication errors in pediatric emergency medicine. Pediatrics 2002; 110:737-742.
Sources and Resources
For more information on use of the color-coded tape, contact:
• Susan Hohenhaus, RN, Project Manager, EMS for Children, Duke University Medical Center, Durham, NC. Telephone: (919) 668-3749. Fax: (919) 668-0484. E-mail: [email protected].
• Paula J. Mialon, PharmD, Senior Clinical Pharmacist, Department of Emergency Medicine, Children’s Medical Center, Dallas, TX 75235. Telephone: (214) 456-2279. E-mail: [email protected].
• Patricia Scott, RN, BSN, CEN, Nurse Leader, Emergency Department, Martin Memorial Medical Center, 300 Hospital Ave., Stuart, FL 34994. E-mail: [email protected].
The Broselow-Luten Pediatric System includes the Broselow Pediatric Emergency Tape. It is a color-coded system that assigns children to color zones based on a single length or weight measurement and enables access to appropriate precalculated medication dosing and formulations and pre-determined equipment sizes. The Broselow Pediatric Emergency Tape costs $120 for five tapes, with shipping charges varying according to destination. To order, contact: Armstrong Medical Industries, 575 Knightsbridge Parkway, P.O. Box 700, Lincolnshire, IL 60069-0700. Telephone: (800) 323-4220 or (847) 913-0101. Fax: (847) 913-0138. Web: www.armstrongmedical.com.
A study packet for the correct use of the Broselow Pediatric Emergency Tape is available at no charge on the Duke University Medical Center "Duke Enhancing Pediatric Safety" web site (www.dukehealth.org/deps). Click on "Broselow Emergency Tape."
In your ED, the color-coded Broselow Pediatric Emergency Tape, a length-based measuring tape that accurately estimates a childs weight, is probably a familiar sight. But are you using the tape correctly?You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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