Independent Double Checks: A Summary
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The document discusses the importance and process of independent double checks (IDCs) in the medication use process to enhance medication safety. It emphasizes that while IDCs can significantly reduce medication errors for high-alert medications, they are often misused and should be implemented strategically alongside other safety measures. Recommendations include clearly defining goals, using IDCs for specific high-risk tasks, and ensuring proper education and documentation to improve patient safety.
Independent Double Checks: A Summary
- 1. Independent Double Checks: A Summary Paul Pasco, BA, BS, PharmD Candidate Medication Safety Intern, UTHSC College of Pharmacy Tuesday, March 8, 2022 1 This Photo by Unknown Author is licensed under CC BY-SA-NC
- 2. OBJECTIVE Summarize the process of independent double checks (“IDCs”) in the medication use process. 2
- 3. SITUATION 3 • Problem: • IDCs for certain high-alert medications • Pharmacists and nurses • Can be effective ➔ often utilized inappropriately • Institute for Safe Medication Practices (ISMP) • Evidence-based recommendations for using IDCs effectively Institute for Safe Medication Practices (ISMP). Independent Double Checks: Worth the Effort if Used Judiciously and Properly. Institute For Safe Medication Practices (ISMP). Published June 6, 2019. Accessed March 6, 2022. https://www.ismp.org/resources/independent-double-checks-worth-effort-if-used- judiciously-and-properly Prescribing Transcribing Dispensing Administration Monitoring
- 4. • IDCs • Two clinicians separately check an order • Prevents errors before dispensing and/or administration • Evaluate patient, dose, drug, etc. • IDCs used to reduce the risk of harm with select high- alert medications • NOT a panacea to prevent errors • IDCs are medium-leverage strategies • Not ideal, especially in isolation • High-leverage strategies should be bundled with IDCs 4 Institute for Safe Medication Practices (ISMP). Independent Double Checks: Worth the Effort if Used Judiciously and Properly. Institute For Safe Medication Practices (ISMP). Published June 6, 2019. Accessed March 6, 2022. https://www.ismp.org/resources/independent-double-checks-worth-effort-if-used- judiciously-and-properly BACKGROUND
- 5. ASSESSMENT 5 • IDCs are often utilized inappropriately • Burnout • Diffusion of responsibility • Used appropriately, IDCs may detect up to 95% of errors • May reduce an errors by a factor of 20 • Sometimes main method for detecting errors • Both checkers still fallible • Ineffective when used for system-level issues that require “hard stops” • Increased likelihood to detect endogenous errors • Decreased likelihood of detecting exogenous errors • Other methods may be more appropriate, require fewer resources Institute for Safe Medication Practices (ISMP). Independent Double Checks: Worth the Effort if Used Judiciously and Properly. Institute For Safe Medication Practices (ISMP). Published June 6, 2019. Accessed March 6, 2022. https://www.ismp.org/resources/independent-double-checks-worth-effort-if-used- judiciously-and-properly This Photo by Unknown Author is licensed under CC BY-NC
- 6. RECOMMENDATIONS 6 • IDCs NOT recommended for ALL high-alert medications • Resistance from staff • Select, very high-risk tasks: • Vulnerable patients (e.g., pediatric populations) • IV opioids, insulin, heparin, chemotherapy • Identify clear goals for the IDC • Verify correct patient, indication, drug, route, etc. • Implement fewer strategic IDCs • Use at most vulnerable points in the medication use process • May use an IDC +/- technology • Manual IDC done independently ➔ avoids confirmation bias • Technology ➔ computerized allergy screening, barcode scanning Institute for Safe Medication Practices (ISMP). Independent Double Checks: Worth the Effort if Used Judiciously and Properly. Institute For Safe Medication Practices (ISMP). Published June 6, 2019. Accessed March 6, 2022. https://www.ismp.org/resources/independent-double-checks-worth-effort-if-used- judiciously-and-properly This Photo by Unknown Author is licensed under CC BY-SA-NC
- 7. RECOMMENDATIONS (CONT.) • When utilizing IDCs: • Outline a clear, specific, succinct, and standardized process for all IDCs • “What do I need to check? How will I check it in a rational way?” • Identify goals • Document ➔ specific checklist • Educate staff • NOT a superficial task • Increases patient safety • Bundle with “hard stops” • Methodist Le Bonheur Healthcare • Policies are congruent with ISMP recommendations and industry standards 7 Institute for Safe Medication Practices (ISMP). Independent Double Checks: Worth the Effort if Used Judiciously and Properly. Institute For Safe Medication Practices (ISMP). Published June 6, 2019. Accessed March 6, 2022. https://www.ismp.org/resources/independent-double-checks-worth-effort-if-used- judiciously-and-properly This Photo by Unknown Author is licensed under CC BY-NC- ND
- 8. SUMMARY 8 • Goals when performing an IDC include two persons each individually verifying correct: • Patient • Indication • Time/date/frequency • Drug • Total dose • Total volume • Rate • Route • Line type • Formulation • Diluent • Container