Transcript Single and double checking in paediatric drug administration

Single and double checking in
paediatric drug administration
– which is most effective in
reducing errors?
Sharon Conroy Lecturer in Paediatric
Clinical Pharmacy, Academic Division of
Child Health, University of Nottingham,
Derbyshire Children’s Hospital, Derby
Single or double checking
in paediatric drug administration – which is
most effective in reducing errors?
Zayed Alsulami
Prof Imti Choonara
Dr Sharon Conroy
Academic Division of Child Health
School of Graduate Entry Medicine & Health,
University of Nottingham, Derbyshire Children’s Hospital, UK
NPPG conference, London 2013
INTRODUCTION
• Double checking by two nurses is a strategy
used by many children’s hospitals to prevent
administration errors
– Conroy S, Davar Z, Jones S. Use of checking systems in medicines administration with
children and young people. Nursing Children and Young People 2012;24:20-4.
• Errors still occur despite this
• There is insufficient evidence to either support
or refute the effectiveness of double checking
in reducing errors
– Alsulami Z, Conroy S, Choonara I. Double checking the administration of medicines: what
is the evidence? A systematic review. Arch Dis Child 2012;97:833-837.
AIMS OF OUR STUDY
• To determine whether single or double
checking is more effective in detecting
and reducing medication errors in
children.
METHODS
• Nurses asked to participate – voluntary and all data
collected was anonymous
• Two scenarios with two patients each were designed.
• Scenarios varied sufficiently to act as independent
test
• In each scenario nurses had to administer:
– 2 oral drugs, 2 IV boluses, 2 IV infusions
• Errors and other confounders built into each
scenario (prescribing & administration)
RESULTS
• 21 nurses took part
• 10 simulations involving double checking
• 20 simulations involving single checking
RESULTS
Double checking simulations
No. of
participants
No. of drugs
administered
No. of
confounders
present
No. of
confounders
not detected
No. of
confounders
detected
Scenario 1
4 pairs
24
12
0
12
Scenario 2
6 pairs
42
30
5
25
Total
20
66
42
5 (12%)
37 (88%)
4 drug contraindications (i.e. Patient is
allergic to penicillin and cefuroxime was
given without asking for confirmation).
1 incomplete allergy information.
RESULTS
Single checking simulations
Scenarios
No. of
participants
No. of drugs
No. of
confounders
present
No. of
confounders
not detected
No. of
confounders
detected
Scenario 1
11
66
33
10
23
Scenario 2
9
63
45
17
28
Total
20
129
78
27 (35%) 51 (65%)
6 incorrect dose frequency prescribed.
5 wrong dose prescribed.
9 drug contraindications
7 incomplete allergy information.
P = 0.0136
RESULTS
Errors and near misses
Errors
Single
checking
• wrong dose of IV cefotaxime
• paracetamol given but chart not signed
• wrong diluent volume added to IV
cefotaxime IV, and wrong dose given
Near miss
• paracetamol
bottle selected
rather than
ibuprofen but
detected before
administration.
• paracetamol / ibuprofen dose not given
Double
Total
• Saline flush syringe not labelled as per
policy
5
-
1
CONCLUSION
• Double checking process more likely to
identify errors and contraindicated drugs
than single checking
• Nurses were more likely to make errors
when administering drugs alone