Independent Double Check definition Open Split View Cite Independent Double Check means a procedure in which two clinicians separately check (alone and apart from each other, then compare results) each component of prescribing, dispensing, and verifying the high - alert medication before administering it to the patient.
Do 2 nurses have to check insulin?
Insulin is a high-risk medication, and The Joint Commission and Institute for Safe Medication Practices recommend that hospital insulin administration be double-checked by nurses.
Why is an independent check performed nursing?
In Brief. NURSES ARE RESPONSIBLE for ensuring the safe care of their patients. Conducting an independent double-check (IDC) when administering high-alert medications is one intervention used to ensure the patient receives medication in the safest manner possible.
Which drugs need to be double checked?
3. Double-checking is a risk management strategy where intravenous, subcutaneous, epidural, intrathecal, and Schedule 8 medications are double checked prior to administration.
What is meant by double checking of medications?
Double checking medication administration involves two individuals verifying the same information, while single checking involves a single individual verifying the information.
What is an independent double check in nursing?
The Institute for Safe Medication Practices (ISMP) defines an independent double check as “a process in which two clinicians independently check each component of prescribing, dispensing, and administering a medication, including the following: • Comparison to prescriber's order.
What is an independent check?
Independent checks on performance, which are carried out by employees who did not do the work being checked, help ensure the reliability of accounting information and the efficiency of operations. For example, a supervisor verifies the accuracy of a retail clerk's cash drawer at the end of the day.
Which medications are considered high alert?
Classes/categories of high-alert medicationsadrenergic agonists, IV (e.g., EPINEPHrine, phenylephrine, norepinephrine)adrenergic antagonists, IV (e.g., propranolol, metoprolol, labetalol)anesthetic agents, general, inhaled and IV (e.g., propofol, ketamine)antiarrhythmics, IV (e.g., lidocaine, amiodarone)More items...•
What are the 5 medication checks?
One of the recommendations to reduce medication errors and harm is to use the “five rights”: the right patient, the right drug, the right dose, the right route, and the right time.
What are the 3 checks before giving medication?
WHAT ARE THE THREE CHECKS? Checking the: – Name of the person; – Strength and dosage; and – Frequency against the: Medical order; • MAR; AND • Medication container.
How do you double check?
To double-check means to review something twice, to be sure that no mistakes have been made. When accuracy is extremely important, one may be asked to triple-check data. However, triple-check is not currently a word recognized by the Oxford English Dictionary.
How do professionals say double check?
synonyms for double checkconfirm.determine.divine.double-check.find out.verify.check.dig.More items...
What is the time difference between two medications?
To avoid the interaction you may need to space the timing of your doses, taking each drug 2 hours before or 4 hours after the other drug.
What is independent nursing check?
Double Independent Checking refers to a process whereby the administering and checking clinicians must each check the required information and, independently confirm the details are correct. These requirements are not new and are consistent with other NSW Health Policies.
Why are independent double checks important?
If the double check is conducted independently, it reduces the risk of confirmation bias that may occur if the same person prepares and checks a medication, as they likely will see only what they expect to see, even if an error has occurred.
What does independent nursing intervention mean?
Independent nursing interventions are those that a nurse can perform on their own, without guidance or supervision from anyone else. Dependent nursing interventions are those that require guidance or supervision from a physician or other medical professional.
What is interdependent care in nursing?
Interdependent: This nursing intervention requires a medical team to care for a patient and depends on orders from physicians or advanced nurse practitioners. An example is treating an injury where the doctor prescribes medicine, the nurse administers it and a physical therapist helps the patient with rehabilitation.
Examples of Independent Double Check in a sentence
Refer to the Procedure section of this document to determine when an Independent Double Check is required prior to the administration of a specific high-alert medication.
Related to Independent Double Check
VRR2 Risk Retention Consultation Party The Risk Retention Consultation Party selected by DBNY.
Why do double checks fail?
Double checks will sometimes fail for a variety of reasons, not the least of which is that the process essentially depends on one fallible person assessing another fallible person’s work. Human performance limits foretell inevitable slips, lapses, and mistakes that will result in an occasional failed check system.
What is manual double check?
A manual independent double check of high-alert medications is a strategy that has been widely promoted in healthcare to help detect potentially harmful errors before they reach patients. 1-3 However, independent double checks used as a risk-reduction strategy have long been disputed as well as misused in healthcare. Its use has been a source of stress for busy prescribers, pharmacists, and nurses who are short on time. Its impact on safety has been questioned by those who rarely find mistakes during the checking process. Its inconsistent use and variability in how the task is carried out has rendered it incapable of detecting many errors. Its overuse as a risk-reduction strategy for high-alert medications has been called to task given its status as a weak error-reduction strategy, particularly if it is the only safeguard in place. Its frequent misuse as a quick fix for an ailing medication use system has been the bane of managers who have investigated serious errors that have reached a patient due to a failed double-check process.
How important is independent double check?
Despite these challenges, ISMP believes that the selective and proper use of independent double checks can play an important role in medication safety . As documented in Table 1, numerous studies have demonstrated the ability of independent double checks to detect up to 95% of errors. 4-10 Based on this, an error rate of 5% (1 in 20) can be reduced to 0.25% (1 in 400) by introducing an independent double-check process. While automated double checks such as barcode scanning may yield even better results, there is enough evidence today to suggest that carrying out a manual independent double check is worth the time and effort if this strategy is planned and carried out as follows.
What is missing in the double check process?
What is often missing in the double-check process is a “sterile cockpit” environment without extraneous conversation and a more cognitive review of all components of the medication, beyond verification of the “5 rights,” that require purposeful thought. Is the drug appropriate for the patient? Does the drug’s indication match the patient’s diagnoses or conditions? Is the dose appropriate for this patient? Is the route of administration proper? These questions and more need to be answered independently by the initial clinician preparing the selected medication for dispensing and administration and the second clinician double checking the medication. See Table 2 for other items to consider when conducting an independent double check. Without a cognitive review of the prescribed medication during a double-check process, errors—particularly prescribing errors that may be overlooked if simply matching the drug order with the product—may not be detected and corrected before reaching the patient.
How do endogenous errors occur?
An endogenous error arises solely within an individual from a random and unpredictable cognitive event like miscalculating a dose. 15 Another person performing the same function will rarely make the same exact mistake. Therefore, endogenous errors are likely to be detected if a double check is performed independently by another person. An exogenous error arises from conditions in the external environment, such as poor design of drug packages and labels, complex task characteristics, or unclear presentation of information. 15 Double checks are often less successful in detecting exogenous errors, even when the check is performed independently. Some of the same external factors that initially led to the error are often still present, and people in the same environment could easily make the same mistake during the double check.
What are the problems with double checking?
These failed checking processes can often be traced to common themes: auto-processing in which the person checking the work of another does so in a habitual manner with little real appraisal; a deference to authority in which the person checking the work of someone who outranks them may not ask questions; a reduction of responsibility or overreliance on double checking in which staff believe someone else will catch any mistakes; social interactions that can lead to unrelated conversations that interfere with the checking process; and lack of time. 11
Why not use double checks?
Also, do not use double checks as a means of fixing problems when more fundamental system redesign is needed. 14 Independent double checks are a poor substitute for system improvements that will actually help prevent errors. Strategies with higher leverage—use of barriers, improving access to information, standardization, and automation, for example—should be considered. Any errors uncovered during the double-check process should also be used for learning and system improvement.
What does the framework add to research?
We believe that without a clear definition of ‘checking procedures’ the evidence base for double-checking will remain at best vague—simply because it is unclear what the investigated intervention precisely is. We presented a framework to conceptualise the various activities covered under the term double check along the information-processing tasks they consist of. Evaluating the correctness of a prescription may best be done in performing a plausibility review, while checking whether one is about to administer it to the right person or whether a programmed infusion rate is correct represents a typical task to be fulfilled in performing a (double) check.
Why are plausibility reviews not effective?
As reported above, plausibility reviews may not be effective if conducted within a checking situation because it needs critical thinking instead of mechanistic information comparison. The fact that the wrong dose error actually needed critical thinking to be identified may be the main explanation for the finding that less errors were identified in the wrong dose scenario, in addition to the reason that different drugs were used for the single and the double check scenarios. 23
What is the best way to evaluate the correctness of a prescription?
Evaluating the correctness of a prescription may best be done in performing a plausibility review, while checking whether one is about to administer it to the right person or whether a programmed infusion rate is correct represent s a typical task to be fulfilled in performing a (double) check.
What is plausibility review?
In a plausibility review, information is not compared, but evaluated: for example, when a nurse checks a prescription and realises that the drug needs to be diluted in a different carrier solution. The nurse identifies the error by using own knowledge. Plausibility reviews are common in healthcare, at least implicitly, and are often executed without being part of standard protocols or written-down procedures. 18
What is double checking framework?
The presented framework conceptualising double checking is intended to serve research and practice. In providing a basis for specifying the activity investigated, future effectiveness studies will be easier to plan, compare and evaluate in their significance. We hope that in using the specific descriptions of checking procedures, future studies will more easily build on each other. Translating empirical evidence into practice will also be easier if the specific procedures studied are known and described. Furthermore, guidelines and standard operating procedures will hopefully benefit from a more concise use of concepts. The framework’s concepts furthermore are useful to assess the types of checks performed along a medication process by different professional groups to identify loopholes and redundancies. 22
Why is double checking important?
Double checking is often considered a useful strategy to detect and prevent medication errors, especially before the administration of high-risk drugs. 1 2 From a safety research perspective, the effectiveness of double checking in preventing medication errors is limited by several factors, ...
What is the most common check procedure?
The most common checking procedures are single checks, and double checks by two persons, which may either be performed sequentially after each other or simultaneously in a common read-read back procedure. Table 1 shows how different ways to involve persons in a double check can be systematically differentiated.
What is double checking?
Double checking is a standard practice intended to improve patient safety. It is used in different areas of health care, such as medication administration 1, 2, 3, radiotherapy 4and blood transfusion 5. Some studies have found double checking to be a useful practice 6, which has been endorsed by agencies and individuals 7, 8, 9, 10. The confidence in double checking exists in spite of the lack of evidence substantiating its effectiveness. Alsulami, Choonara and Conroy 11undertook a systematic review of double checking and found that there is a paucity of evidence, particularly randomized controlled trials, to justify the practice of double checking. Armitage noted that Leape had identified double checking as a ‘sacred cow’ that ‘zaps time and is ineffective’ 12, 13.
What are the weaknesses of double checking?
Weaknesses in the double checking process include inconsistent conceptualization of double checking, double (or more) checking as a costly and time‐consuming procedure, double checking trusted as an accepted and stand‐alone process, and double checking as preventing reporting of near misses. Alternate views of double checking that would render it a more robust process include recognizing that double checking requires training and a dedicated environment, Introducing automated double checking, and expanding double checking beyond error detection. These results are linked with the concepts of collective efficiency thoroughness trade off (ETTO), an in‐family approach, and resilience.
What is double checking in interview?
Double checking with a peer: Some interviewees referred to double checking as involving a colleague looking over a situation with them to see if there were any problems.
How long was the interview in the case study?
This study underwent ethics review at both the hospital site of the case study, and the researchers' university. Interviews lasted about 45 minutes, and were captured on a digital voice recorder and transcribed verbatim. Atlas ti software (GmbH, Berlin, Germany) was used to code the data. The analytical approach was both inductive and deductive 22. The first four themes presented were inductively derived (informed principally by the data), whereas the second three themes were deductively derived (indications in the data were further developed based on extant literature). Iteratively moving between the data and the literature, we identified themes of weaknesses in and alternative views of the double checking practice.
Is double checking a practice?
Double checking is a standard practice in many areas of health care, notwithstanding the lack of evidence supporting its efficacy. We ask in this study: ‘How do front line practitioners conceptualize double checking? What are the weaknesses of double checking? What alternate views of double checking could render it a more robust process?’
When was the GIM data collection?
Data collection was undertaken in General Internal Medicine (GIM) and Obstetrics and Neonatology (OBS/NEO) between spring 2012 and fall 2014. Our data collection in each department started with our attendance to a quality review meeting where the researchers were introduced to key personnel who would later become interviewees. These key informants helped us extend our sample by contacting managers and practitioners. Over a period of 5 months in each division, two researchers (both independently and together) confidentially interviewed 85 participants, as shown in Table 1.
Where is the 2Telfer School of Management?
2Telfer School of Management, University of Ottawa, Ottawa, Ontario, Canada
