Targeting what matters: A quasi-experimental controlled before-and-after study on targeted double checks in parenteral medication administration

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BACKGROUND: Parenteral medication administration is associated with a substantial risk of medication errors. Independent double-checking by two nurses is widely mandated to reduce this risk; however, evidence is lacking, compliance is inconsistent, and the procedure is time-consuming. Medication safety organisations increasingly recommend targeted double-checking of high-risk medications, yet the impact of such a strategy in clinical practice remains unclear. This study evaluated the effect of implementing targeted double-checking, alongside barcode verification, on compliance with predefined safe administration procedures during parenteral medication administration. METHODS: A quasi-experimental controlled before-and-after study was conducted on two comparable surgical wards in a Dutch university hospital between June 2022 and January 2024. On the intervention ward, parenteral administrations were categorised as high or low risk, with double-checking required only for high-risk administrations alongside mandatory barcode verification. The control ward continued universal double-checking combined with barcode verification for both high- and low-risk administrations. The primary outcome was the percentage of safe administrations, defined as compliance with predefined safety administration procedures according to administration risk level. Secondary outcomes included barcode verification rates, double-check application rates, medication errors, voluntarily reported incidents, and administration time as a measure of efficiency. Outcomes were assessed using disguised observations and retrospective data analysis. Data were analysed using descriptive statistics and Chi-square or Fisher's exact tests. RESULTS: A total of 250 administrations were observed. Compliance to safe administrations increased on the intervention ward from 0% to 41% (p < 0.001) and on the control ward from 16% to 35% (p = 0.025). Double-check application decreased on the intervention ward (60% to 11%, p < 0.001) but increased on the control ward (0% to 16%, p = 0.002). Barcode verification during observations increased on the intervention ward (53% to 76%, p = 0.007) and decreased on the control ward (71% to 31%, p < 0.001). Retrospective analysis showed improved patient and medication barcode verification on the intervention ward (15% (1446/9567) to 51% (579/1133), p < 0.001) and a decline on the control ward (18% (1759/9857) to 12% (150/1229), p < 0.001). Implementation of targeted double-checking was associated with an estimated saving of 48 minutes of nursing time per day. No medication errors or incidents were reported. CONCLUSION: Targeted double-checking combined with barcode verification appears to improve compliance with safe administration procedures during parenteral medication administration; however, improvements on the control ward preclude definitive conclusions regarding effectiveness. This targeted strategy may provide a sustainable alternative by reducing unnecessary procedural burden while improving patient safety. Further research is needed to evaluate this effect.

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