Medication double-checking procedures in clinical practice: a cross-sectional survey of oncology nurses' experiences

Abstract

BackgroundDouble-checking is widely recommended as an essential method to prevent medication errors. However, prior research has shown that the concept of double-checking is not clearly defined, and that little is known about actual practice in oncology, for example, what kind of checking procedures are applied.ObjectiveTo study the practice of different double-checking procedures in chemotherapy administration and to explore nurses' experiences, for example, how often they actually find errors using a certain procedure. General evaluations regarding double-checking, for example, frequency of interruptions during and caused by a check, or what is regarded as its essential feature was assessed.MethodsIn a cross-sectional survey, qualified nurses working in oncology departments of 3 hospitals were asked to rate 5 different scenarios of double-checking procedures regarding dimensions such as frequency of use in practice and appropriateness to prevent medication errors; they were also asked general questions about double-checking.ResultsOverall, 274 nurses (70% response rate) participated in the survey. The procedure of jointly double-checking (read-read back) was most commonly used (69% of respondents) and rated as very appropriate to prevent medication errors. Jointly checking medication was seen as the essential characteristic of double-checking—more frequently than ‘carrying out checks independently’ (54% vs 24%). Most nurses (78%) found the frequency of double-checking in their department appropriate. Being interrupted in one's own current activity for supporting a double-check was reported to occur frequently. Regression analysis revealed a strong preference towards checks that are currently implemented at the responders' workplace.ConclusionsDouble-checking is well regarded by oncology nurses as a procedure to help prevent errors, with jointly checking being used most frequently. Our results show that the notion of independent checking needs to be transferred more actively into clinical practice. The high frequency of reported interruptions during and caused by double-checks is of concern.

The impact of interruptions on medication errors in hospitals: an observational study of nurses

“…Similar approaches that use electronic checking approaches where the staff member is checking with a computer may provide some relief if used within the regulatory requirements of the health services. Further, a recent study of double checking practices of oncology nurses has highlighted that there is evidence of jointly double-checking medications rather than independent checking of medications diminishing the benefits to patient safety (Schwappach et al 2016). The high frequency of interruptions during this joint double-checking process was particularly problematic in our study (Schwappach et al 2016).…”

“…Further, a recent study of double checking practices of oncology nurses has highlighted that there is evidence of jointly double‐checking medications rather than independent checking of medications diminishing the benefits to patient safety (Schwappach et al . ). The high frequency of interruptions during this joint double‐checking process was particularly problematic in our study (Schwappach et al .…”

“…The high frequency of interruptions during this joint double‐checking process was particularly problematic in our study (Schwappach et al . ).…”

Double checking injectable medication administration: Does the protocol fit clinical practice?

“…Most studies reported that the double check process is poorly defined and that many variations of the double check process are executed in hospitals (Dickinson et al, 2010;Kellett and Gottwald, 2015). One detailed process description is the read-read back method from (Schwappach et al, 2016): one nurse reads out loud the medication order and another nurse verifies this on the medication label and vice versa. However, this study is different from ours since it is conducted on an oncology ward and focused on chemotherapy, and the role of the barcode scanner is unclear in the various scenario's.…”

“…While previous studies focused only on compliance and the absence of the double check (Alemanni et al, 2010;Alsulami et al, 2014;Schwappach et al, 2016;Sheu et al, 2009), extra understanding is needed about how nurses actually conduct the double check proceeding in everyday clinical practice. After all, most of the work seems to be carried out safely and without harming patients.…”