RT Journal Article SR Electronic T1 Associations between double-checking and medication administration errors: a direct observational study of paediatric inpatients JF BMJ Quality & Safety JO BMJ Qual Saf FD BMJ Publishing Group Ltd SP 320 OP 330 DO 10.1136/bmjqs-2020-011473 VO 30 IS 4 A1 Johanna I Westbrook A1 Ling Li A1 Magdalena Z Raban A1 Amanda Woods A1 Alain K Koyama A1 Melissa Therese Baysari A1 Richard O Day A1 Cheryl McCullagh A1 Mirela Prgomet A1 Virginia Mumford A1 Luciano Dalla-Pozza A1 Madlen Gazarian A1 Peter J Gates A1 Valentina Lichtner A1 Peter Barclay A1 Alan Gardo A1 Mark Wiggins A1 Leslie White YR 2021 UL http://qualitysafety.bmj.com/content/30/4/320.abstract AB Background Double-checking the administration of medications has been standard practice in paediatric hospitals around the world for decades. While the practice is widespread, evidence of its effectiveness in reducing errors or harm is scarce.Objectives To measure the association between double-checking, and the occurrence and potential severity of medication administration errors (MAEs); check duration; and factors associated with double-checking adherence.Methods Direct observational study of 298 nurses, administering 5140 medication doses to 1523 patients, across nine wards, in a paediatric hospital. Independent observers recorded details of administrations and double-checking (independent; primed—one nurse shares information which may influence the checking nurse; incomplete; or none) in real time during weekdays and weekends between 07:00 and 22:00. Observational medication data were compared with patients’ medical records by a reviewer (blinded to checking-status), to identify MAEs. MAEs were rated for potential severity. Observations included administrations where double-checking was mandated, or optional. Multivariable regression examined the association between double-checking, MAEs and potential severity; and factors associated with policy adherence.Results For 3563 administrations double-checking was mandated. Of these, 36 (1·0%) received independent double-checks, 3296 (92·5%) primed and 231 (6·5%) no/incomplete double-checks. For 1577 administrations double-checking was not mandatory, but in 26·3% (n=416) nurses chose to double-check. Where double-checking was mandated there was no significant association between double-checking and MAEs (OR 0·89 (0·65–1·21); p=0·44), or potential MAE severity (OR 0·86 (0·65–1·15); p=0·31). Where double-checking was not mandated, but performed, MAEs were less likely to occur (OR 0·71 (0·54–0·95); p=0·02) and had lower potential severity (OR 0·75 (0·57–0·99); p=0·04). Each double-check took an average of 6·4 min (107 hours/1000 administrations).Conclusions Compliance with mandated double-checking was very high, but rarely independent. Primed double-checking was highly prevalent but compared with single-checking conferred no benefit in terms of reduced errors or severity. Our findings raise questions about if, when and how double-checking policies deliver safety benefits and warrant the considerable resource investments required in modern clinical settings.