How the Color Coding Kid Hospital System works

When an adult comes into the emergency room, they are often given a standard dose of medication. When a child comes in to the emergency room, however, doctors and nurses must quickly figure out their weight in order to determine the proper dose to administer. The Color Coding Kids Hospital System is designed to make the calculation of medication or fluid dose for any child under 12 years of age quick and easy. The color code based system allows medical personnel to determine the weight of a child nearly instantaneously and in turn give them the proper amount of medication as soon as possible. Developed by Dr. Jim Broselow, a board certified physician in family and emergency room medicine, and Dr. Bob Luten, a professor of pediatrics and emergency medicine at the University of Florida, the system helps enhance pediatric safety and reduces injuries to children due to improper administration of medication.

Medication administration to a pediatric patient involves many factors. Medication dosages typically are based upon the child’s weight in kilograms. To provide the proper dosage of a medication to the child, the practitioner must know the child’s weight, the dose per kilogram, and the available concentrations of the specific drug. Pediatric resuscitation drugs are not used often enough to recall the correct dosage, and valuable time is taken to look up the correct dosage by weight. Calculations required may include conversion of weight from pounds to kilograms, as well as dose by weight and concentration of the drug.

Color Coding Kids Hospital System

By using a color-coded system tool, the practitioner is able to concentrate on more important factors of care during the emergency, such as securing the airway, maintaining circulation, making a diagnosis and securing appropriate transport. The length measurement is taken directly from the child and a color is assigned. The practitioner does not need to rely on memory or calculations to select the appropriate size equipment or drug dosage. Equipment and even medications can be organized and stored by color to permit easier access in an emergency.

The original tape was the invention of Dr. Jim Broselow, an emergency physician in Hickory, North Carolina. By his own admission, as a family physician he felt pretty comfortable with caring for very sick adults, but when the patient was a critically ill or injured child, he describes chaos, terror and lack of confidence on the part of emergency care providers. He was sure that there was a better way to care for these children that would provide consistency and standardization.

Dr. Broselow developed a simple tool to increase the accuracy of weight estimation using height-weight correlations from the National Center for Health Statistics (NCHS)9. The Broselow Tape has become an industry standard in pediatric emergency care.

After the development of the original tape, Dr. Broselow teamed up with Dr. Bob Luten, a Pediatric Emergency Physician from Jacksonville, Florida. Together, with the input of other colleagues, they have developed the latest tape and other items that enhance the system. Its development is based on more than 20 years of emergency department use.

Use of the tape has been the subject of several studies that validate its use. Analysis shows that mean medication dosing error severity when subjects used the B-LPS was 33.88% lower then when B-LPS was not available.

The Full Hospital System

The Broselow-Luten System is a standardized therapeutic system whose goal is to increase safety, efficiency and comfort level whenever and wherever children receive medical treatment both by health care professionals and the lay public. It is an extension and enhancement of the “Broselow Tape” and corresponding equipment organization system which is now widely used in the treatment of pediatric emergencies. The essence of the new system has been the development of color-coded dosing zones which are specifically designed to accommodate not only equipment selection as in the present system but also to fall within the generally accepted therapeutic ranges of medications, thus allowing “zone dosing” for multiple therapeutic parameters. These zones are accessed by patient weight when available, but they can also be accessed by patient length when accurate weights are not known such as for emergencies or selected home use.

Once the appropriate color has been selected, it is used to access therapeutic information utilizing the color-coded tools and references which make up the system. These tools address not only physician based aspects such as calculating and communicating the correct dose in milligrams but also nursing concerns such as translating a given order into the appropriate number of milliliters of a given concentration to be delivered to the patient. It is a visual system in which the color eliminates the need for mathematics or memorization thereby allowing almost instantaneous access to appropriate size related pediatric parameters. The color functions as well as part of a ‘failsafe’ system, easily understood by all members of the therapeutic team, which encourages a “team approach” to error prevention.

General electric’s recent initiative to incorporate the system into their CT imaging software in an attempt to decrease the risk of future cancer by reducing radiation exposure to children is a good example of how setting a common standard can enhance care while enhancing patient safety in related areas of medicine. A study in the Archives of Pediatrics and Adolescent Medicine, 3-03, helps quantifies the efficacy of this approach.