Improving patient safety through safe dosing

1. APRIL | 2017 SPOTLIGHT ON JAMES BROSELOW, MD, eBroselow
“With my background in family
medicine, emergency medicine
was not difficult to learn, but
in the early 1980’s we were
terrified when an acutely ill
or injured child came into the
emergency room. There were no
tools to treat a child then and
everyone struggled.” Dr. James
Broselow, founder of eBroselow,
admits he never set out to save
the world, but recognized the
need to develop a reliable
tool to help solve preventable
patient death, the third leading
cause of death in the United
States today. Much like the
Broselow Tape, Dr. Broselow’s
SafeDose Scan, improves
preventable patient death and
significantly reduces medication
error amongst the pediatric
patient population. SafeDose
Scan is a valuable solution for
medication safety, emergency
medicine, and improves the
quality of our healthcare system
as a whole.
_________________________
PSMF: Introduce yourself and how
your career in pediatrics started.
BROSELOW: My name is James
Broselow. My career initially started
as a family doctor. In 1983 I started
moonlighting in the emergency
department and enjoyed it, so I
switched careers and started working
full-time at a small community
hospital. The community hospital was
not very busy, so I had the time and
opportunity to study my new role
in emergency medicine. It was not
long before I became comfortable
treating adults in the emergency
department…but kids were different.
I don’t remember ever being as
nervous as I was when I faced my first
critically ill child. There was so much
on the line and everyone else was just
as nervous as I was! I clearly needed
help, or a “tool” of some kind. Not
long after, the Broselow Tape and
Color-Coded Crash Carts were born.
PSMF: How did the development
of your concept the, Broselow
Tape, begin?
BROSELOW: I was convinced the
answer was some kind of tape
measure that measured dose rather
than length, but I had to prove that
it actually worked. So, I set out to do
a case study using several pediatric
offices in rural North Carolina to test
my ideas. The first step was to make a
prototype tape. I used the height and
weight table from my Nelson’s text
book as a reference. My neighbor,
a CPA who had a computer at the
time, turned my table into length
zones. Then, I sent the data I had
collected to Lenoir-Rhyne University,
our home college in North Carolina,
and the head of statistics took the
data on as a course project. When
PALS (Promoting Active Learning and
Service) faculty did a large national
study, the data I had submitted had
held up. The evidence that length
could predict emergency doses
in children was there, which laid
the foundation for the Broselow
tape. Soon after, I partnered with
Bob Luten, a PALS faculty member,
and Allen Hinkle, a pediatric
anesthesiologist. We proved that
length could also predict equipment
size and ultimately used that concept
to develop the matching coded color-
crash carts.
PSMF: As inventor of the Broselow
tape, what influenced your decision
to take your innovation and use it to
develop an electronic drug dosing
and tracking system?
BROSELOW: I kiddingly always say,
“I didn’t invent the Broselow tape,
the Broselow tape invented me!” I
had learned an important lesson;
I learned that it was possible to
standardize one small, but important,
aspect of emergency medicine. The
tape opened up many opportunities,
and ultimately led to the start of my
new company, eBroselow. eBroselow
is focused on using technology
to expand safety, way beyond
the limitations implicit in writing
information in a small box, on a tape
measure. To really scale the tape
concept, it had to go digital. The
need for technology came in because
human error is inevitable. Every study
out there proves it.
PSMF: How did your idea to turn
the Broselow Tape into an easy to
use web application, SafeDose Scan,
initially take shape?
BROSELOW: The analogy I use to
explain the concept behind SafeDose
Scan starts at the Supermarket. If
properly trained, a supermarket’s
staff knows food pricing and what is
on sale, yet they never do math or
memorize the prices. They simply
scan the can of soup and there it is…
transparent to everyone. Why not
apply that same concept to safeguard
medication administration? A device,
that to a similar degree, scans a
barcode, does math for you, and
never makes an error? It is used every
day in supermarkets, why don’t we
have a logical solution in healthcare
that does the same? Now let me ask
you a question, when a child’s life is
on the line, would you rather do the
math in your head or use a scanner
that spits out an accurate dosage
within seconds?
PSMF: You received second place
in last year’s 2016 Patient Safety
Innovation Awards for identifying an
area in dire need for improvement
and creating a product that has
positively changed the quality of
medication administration and the
treatment of pediatric patients,
what’s next?
BROSELOW: I have to say, the work
I have done is only a microcosm of
what the Patient Safety Movement
Foundation is doing. The Movement
has brought together an engaged
and multi-faceted group of
passionate individuals who are all
after the same end goal; to provide
safe, high quality and resilient care to
patients and reach zero preventable
deaths by 2020 (0X2020). We can
solve preventable patient death
with simple tools and information
we already have. My focus is to
support the Patient Safety Movement
Foundation’s efforts in my role as a
Patient Safety Movement Foundation
Ambassador for Pediatrics. In this
role, I plan to spread awareness
on simple, existing tools that offer
valuable solutions to eliminate
errors and avoidable death. I
encourage healthcare systems and
all stakeholders to make use of these
existing best practices and to join us
on the journey to zero.
JAMES BROSELOW, MD
eBroselow