Table 1

Studies using an observational study design investigating double checking of medication administration

StudyCountrySample size/study durationSettingMethod of measuring double checkingMethod of measuring errorsFindingsStudy quality
Jarman 2002*27 Australia14 monthsInpatient units, operating suites, birthing suite and ED at a 400-bed academic tertiary care hospitalNone (before and after study of change in policy)Incident report forms
  • 4 administration errors were measured from March through September 2000 (when double checking was required) compared with 5 errors from March through September 2001 (when single checking became standard)

Manias 200531 Australia175 administrations to 47 patients over 2 monthsMetropolitan academic teaching hospitalDirect observation
  • Adherence rate was 97% for double checking of preparation and 80% for double checking to the patient’s bedside

Conroy 200730 UK752 administrations to 253 patients over 6 weeksMedical and surgical wards, PICU, NICU, ED in a 92-bed paediatric hospitalDirect observationDirect observation
  • In 84% of patients, nurses were observed to double check administrations

  • Cursory double checks were done on oral drug volumes and intravenous infusions in 3% of patients

  • Independent checks of calculations were not obvious in 2% of patients

  • Student nurses were allowed to administer unsupervised in 1% of patients

Alsulami 201428 UK2000 administrations to 876 patients over 4 monthsMedical and surgical wards, PICU, NICU in a paediatric hospitalDirect observationDirect observation
  • Among 15 steps of independent double checking, adherence rates were equal or greater than 90% for 11 steps

  • For the four other steps, adherence rates were 83% for the actual administration, 71% for rate of intravenous bolus, 67% for labelling of flush syringes and 30% for dose calculation

Bulbul 201429 Turkey98 nursesPaediatric emergency, paediatric and neonatology, paediatric surgery wards in two teaching and research hospitalsSelf-reportSelf-report
  • 64% of nurses reported double checking while preparing or administering high-risk drugs

Schilp 201432 Netherlands2154 administrations of intravenous drugs over 1 year ICU, internal medicine, general surgery and other departments administering intravenous drugs in 19 hospitals (2 academic, 6 tertiary teaching, 11 general)Direct observation
  • Adherence to double checking was 52% for administrations of intravenous drugs

Härkänen 201534 Finland1058 administrations to 122 patients over 2 monthsMedical and surgical wards in an 800-bed academic hospitalDirect observationDirect observation, medical records
  • In multivariate regression, double checking was significantly associated with a lower odds of any medication error (OR 0.44 (0.27 to 0.72))

  • Adherence to double checking was 81%

Young 201533 USA60 administrations to 47 paediatric and 10 adult patients over 24 days198-bed paediatric inpatient hospitalDirect observationDirect observation
  • Adherence to double checking was 75% (9 out of 12) among continuous intravenous administrations

Cochran 201626 USA6497 administrations to 1374 patients12 rural hospitalsDirect observationDirect observation, medical records
  • 16 of 29 (55%) preparation and administration errors occurred from administrations done with a single check, 9 (31%) with a double check and 4 (14%) with bar-code administration

Subramanyam 201619 USA1473 intravenous infusions over 1 yearPaediatric patients undergoing radiological imaging at a tertiary academic paediatric hospitalSelf-reportSelf-report
  • Intercepted errors decreased from 4 per month to 1 per month

  • Adherence to double checking was reported to be over 90%

  • *This study used a before-and-after design. All other studies were observational cohort studies.

  • ED, emergency department; NICU, neonatal intensive care unit; PICU, paediatric intensive care unit.