A presentation I gave during an internship/Advanced Pharmacy Practice Experience (APPE) in medication safety at a hospital.

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
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• 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
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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
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• 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
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• 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
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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
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• 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