Beyond Broselow

Beyond Broselow

Broselow Pediatric Emergency Tapes and their respective equipment are a fast way to assure that pediatric patients of all sizes receive safe and efficient emergency care during a crisis. However, the Joint Commission’s move to require standardized concentration of medication drips has resulted in Requirements for Improvement stemming from their use.

Out With the Old, In With the New and MORE

Prior to the publication of the 2007 edition of the Broselow Pediatric Emergency Tape, the back of the tape instructed staff as to how to mix a customized concentration of an emergency infusion by adding X.X cc of the drug, filling 100 cc, and running it at a standardized rate, such as 10 cc per hour. Based on the weight of the individual patient, the resulting concentration of the drip wouldvary greatly within the same pediatric ICU. The National Patient Safety Goal, which has since migrated to standard MM.2.20, EP #10, does not permit the use of the customized concentrations. The standard requires that the organization standardize and limit the number of concentrations to only those required for patient care.

Preventing RFIs

To prevent the chance of receiving a Requirement for Improvement:

  • Assure that your current Broselow tape has been updated to reflect the expectations of the National Patient Safety Goal. You can tell by looking on the back where the section on infusions only contains a note about the National Patient Safety Goals.
  • Add a reference source to your code cart on the preparation and administration of emergency drug infusions for your pediatric patients. While used rarely, references to pediatric infusions may be needed in an emergency, and are critical for response teams to mix efficiently.  Whether your reference is commercially prepared (there are some cart manufacturers who do offer a reference for about $75) or home grown, make sure the reference can pass the following tests:
    • Does the reference ONLY include dosing instructions for the premixed medication solutions present in YOUR cart?  If the reference contains other concentrations, have steps been taken to make sure staff do not use these (such as removing them or blacking through the information)?
    • Does the reference follow the same increments (2 kg, 2.5 kg, etc.) as any other drug references in use, such as the Broselow tape?
  • In addition, ask yourself the following questions:
    • Has education been completed to assure that staff members are familiar with how to use the tapes and accompanying information?
    • During mock code drills, is the selection, calculation, and administration of medicated drips included in the drill (high-risk, problem-prone step)?
Tracer Tips

When testing compliance with the expectations related to Broselow carts, consider asking the following questions during tracers:

  • How do you determine how much epinephrine to give a baby weighing 4.5 kg?
  • How would you prepare and give an ongoing drip if ordered?
  • Is the order for administration read back to the prescriber?
  • If the infusion is to be mixed and not provided as a premixed bag, survey the following:
    • Are the infusions prepared using sterile techniques? (MM.4.20)
    • Is the resulting infusion labeled appropriately? (MM.4.30)
    • Are the bottles kept in case they are needed for reference until the end of the code? (Best practice, but not required – this reflects NPSG regarding labeling.)