Does an Insulin Double-Checking Procedure Improve Patient Safety?

Modic, Mary Beth; Albert, Nancy M.; Sun, Zhiyuan; Bena, James; Yager, Christina; Cary, Theresa; Corniello, Amanda; Kaser, Nancy; Simon, Julie; Skowronsky, Catherine; Kissinger, Brian

doi:10.1097/nna.0000000000000314

Cited by 13 publications

(33 citation statements)

References 8 publications

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“…Nineteen articles were excluded during full-text review since they did not report any measure of association between double checking and MAEs, or double checking adherence rate. Thirteen articles were included in the final review, which comprised five articles reporting the association between double checking and MAEs,16 23 25–27 six articles reporting adherence rates28–33 and two articles reporting both measures 19 34. No studies assessed patient harm as an outcome.…”

Section: Resultsmentioning

confidence: 99%

“…The studies in the final review included 10 studies using an observational study design,19 26–34 two RCTs16 23 and one RCT conducted in a simulated setting 25. Studies using an observational study design are described in table 1 and RCTs in table 2.…”

Section: Resultsmentioning

confidence: 99%

“…Studies using an observational study design are described in table 1 and RCTs in table 2. Seven studies were conducted among adult patients,16 23 26 27 31 32 34 one used a simulated adult patient25 and five involved paediatric patients 19 28–30 33. The majority of studies investigated all types of medications administered in the hospital, while three investigated only specific parenteral drugs 19 23 32.…”

Section: Resultsmentioning

confidence: 99%

“…Study quality varied, and many studies were underpowered to provide meaningful results regarding the association between double checking and MAEs. Three studies had small study populations,25 29 33 and five studies relied partially or completely on self-report to measure medication errors, likely resulting in a large under-ascertainment of actual error rates 16 19 23 27. Furthermore, one of these studies used self-report only for double-checked administrations and medical record review for single-checked administrations, possibly biasing results towards a positive association between double checking and a reduced medication error rate 23.…”

Section: Resultsmentioning

confidence: 99%

“…Effect estimates for the association between double checking and MAEs or harm, along with corresponding p values and/or CIs, as well as double checking adherence rates were recorded. For one study,23 error-free medication administration rates were transformed into error rates for consistency with other studies. Study quality was measured using the assessment tools provided by the National Institutes of Health,24 assigning each study a rating of ‘poor’, ‘fair’ or ‘good’.…”

Section: Methodsmentioning

confidence: 99%

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Effectiveness of double checking to reduce medication administration errors: a systematic review

Koyama

Maddox

et al. 2019

BMJ Qual Saf

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BackgroundDouble checking medication administration in hospitals is often standard practice, particularly for high-risk drugs, yet its effectiveness in reducing medication administration errors (MAEs) and improving patient outcomes remains unclear. We conducted a systematic review of studies evaluating evidence of the effectiveness of double checking to reduce MAEs.MethodsFive databases (PubMed, Embase, CINAHL, Ovid@Journals, OpenGrey) were searched for studies evaluating the use and effectiveness of double checking on reducing medication administration errors in a hospital setting. Included studies were required to report any of three outcome measures: an effect estimate such as a risk ratio or risk difference representing the association between double checking and MAEs, or between double checking and patient harm; or a rate representing adherence to the hospital’s double checking policy.ResultsThirteen studies were identified, including 10 studies using an observational study design, two randomised controlled trials and one randomised trial in a simulated setting. Studies included both paediatric and adult inpatient populations and varied considerably in quality. Among three good quality studies, only one showed a significant association between double checking and a reduction in MAEs, another showed no association, and the third study reported only adherence rates. No studies investigated changes in medication-related harm associated with double checking. Reported double checking adherence rates ranged from 52% to 97% of administrations. Only three studies reported if and how independent and primed double checking were differentiated.ConclusionThere is insufficient evidence that double versus single checking of medication administration is associated with lower rates of MAEs or reduced harm. Most comparative studies fail to define or investigate the level of adherence to independent double checking, further limiting conclusions regarding effectiveness in error prevention. Higher-quality studies are needed to determine if, and in what context (eg, drug type, setting), double checking produces sufficient benefits in patient safety to warrant the considerable resources required.NCT42018103436.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Effectiveness of double checking to reduce medication administration errors: a systematic review

Koyama

Maddox

et al. 2019

BMJ Qual Saf

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Guideline Implementation: Medication Safety

Burlingame¹

2018

AORN Journal

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Costs and Cost-Effectiveness of User-Testing of Health Professionals’ Guidelines to Reduce the Frequency of Intravenous Medicines Administration Errors by Nurses in the United Kingdom: A Probabilistic Model Based on Voriconazole Administration

Jones

Franklin

Raynor

et al. 2021

Appl Health Econ Health Policy

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Aim In the UK, injectable medicines are often prepared and administered by nurses following the Injectable Medicines Guide (IMG). Our earlier study confirmed a higher frequency of correct administration with user-tested versus standard IMG guidelines. This current study aimed to model the cost-effectiveness of user-testing. Methods The costs and cost-effectiveness of user-testing were explored by modifying an existing probabilistic decision-analytic model. The adapted model considered administration of intravenous voriconazole to hospital inpatients by nurses. It included 11 error types, their probability of detection and level of harm. Model inputs (including costs) were derived from our previous study and other published data. Monte Carlo simulation using 20,000 samples (sufficient for convergence) was performed with a 5-year time horizon from the perspective of the 121 NHS trusts and health boards that use the IMG. Sensitivity analyses were undertaken for the risk of a medication error and other sources of uncertainty. Results The net monetary benefit at £20,000/quality-adjusted life year was £3,190,064 (95% credible interval (CrI): −346,709 to 8,480,665), favouring user-testing with a 96% chance of cost-effectiveness. Incremental cost-savings were £240,943 (95% CrI 43,527–491,576), also favouring user-tested guidelines with a 99% chance of cost-saving. The total user testing cost was £6317 (95% CrI 6012–6627). These findings were robust to assumptions about a range of input parameters, but greater uncertainty was seen with a lower medication error risk. Conclusions User-testing of injectable medicines guidelines is a low-cost intervention that is highly likely to be cost-effective, especially for high-risk medicines.

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Does an Insulin Double-Checking Procedure Improve Patient Safety?

Abstract: The subcutaneous insulin double-checking preparation procedure led to less insulin administration errors; however, timing errors were most prevalent and are not resolved with double-checking interventions.

Cited by 13 publications

References 8 publications

Effectiveness of double checking to reduce medication administration errors: a systematic review

Effectiveness of double checking to reduce medication administration errors: a systematic review

Guideline Implementation: Medication Safety

Costs and Cost-Effectiveness of User-Testing of Health Professionals’ Guidelines to Reduce the Frequency of Intravenous Medicines Administration Errors by Nurses in the United Kingdom: A Probabilistic Model Based on Voriconazole Administration

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