Time to Rethink the Independent Double Check: The Impact of COVID-19 on Ensuring Medication Administration Safety Copy

by | Feb 19, 2021

COVID-19 has upended the world as we know it in many aspects of life: business, entertainment, travel, and education just to name a few. Obviously nowhere has the impact of the virus been felt more prominently than in healthcare. Dealing with the virus in addition to handling regular healthcare duties in a hospital setting has put an enormous burden on nurses and clinicians. Ensuring the safety of both patients and staff during the pandemic has been a Herculean task.

Despite the pandemic, ensuring safe medication dosing remains a high priority. Administration errors account for 38 percent of medication errors, about the same as the estimated 39 percent of errors related to medication ordering.[1] One of most important safety measures that has been adopted by most organizations to prevent adverse drug events (ADE) is the independent double check (IDC).

During normal times, adhering to the IDC protocol is a challenge. Nurses must find a colleague – usually interrupting him or her in the process of caring for another patient – to have them double check that the proper medication dose will be administered to the patient. The Institute for Safe Medication Practices (ISMP) reports numerous studies have demonstrated that independent double checks may reduce the rate of medication errors by 95 percent[2] , so as cumbersome as the process can be, it is also critically important.

Increased challenges during COVID-19

But even in normal, pre-pandemic times, it was not always easy to locate a colleague due to short-staffing and other time constraints. Add in the safety measures instituted as a result of a contagious, deadly virus, and continuing the practice of the double check became exponentially more problematic.

There are a number of issues surrounding the collegial double check in a time of pandemic including:

Patient safety – The independent double check, while preventing ADEs, may actually decrease patient safety by bringing additional healthcare staff into a patient’s room. This additional exposure increases the patient’s risk of contracting a nosocomial infection.

Staff safety – Not only are patients at a greater risk, but so are nurses who must enter the room of a potentially infected patient, exposing them to viruses like COVID-19. There are a number of steps hospitals are taking to minimize the need for nurses to enter patient rooms such as putting IV pumps into corridors. Conducting in-room dosing double checks runs counter to these new safety measures.

Diminished resources – According to one hospital study, the time to conduct a double check for the checking nurse alone averaged 6.4 minutes (7.9 minutes for IV and 5.5 minutes for non-IV administrations). With nearly 1800 administrations a day across the hospital and 69.3 percent requiring double checks), the process consumed almost 133 hours a day of nursing time.[3]

The nursing shortage even before COVID-19 was a growing concern. The pandemic has exacerbated that problem as more nurses are stepping away from the profession because of the danger of the virus and the resulting stress it has caused. Nurses are also contracting the virus which has reduced staff levels further. Conducting dosing double checks becomes even more challenging as nursing resources become scarcer.

Increased costs – Every time a nurse has to enter a room with a COVID-19 patient – or patients with influenza, VRE, MRSA, or other communicable diseases – he or she must use Personal Protective Equipment (PPE). Having a second nurse enter a room to perform a dosing double check increases the amount of PPE being consumed and increases the hospital’s costs.

PPE costs have increased an average of over 600 percent since the beginning of the COVID-19 crisis, especially the cost of isolation gowns, N95 masks, and face shields. The average pre-pandemic full-PPE cost per use was $2.83. During the pandemic, the cost has risen to $16.19 per use for an attire of masks, face shields, gowns, gloves, and shoe covers.[4]

Solving the problem

Because of these issues, many hospitals are modifying the number of drugs that require an independent double check during the pandemic. That may save costs and time while limiting exposure to the virus for both patients and nurses, but that policy comes at the risk of increasing the likelihood of an ADE.

There is another way.

SafeDose provides a technology solution that eliminates the need to interrupt a second nurse and to either expose a patient or have that nurse be exposed to a deadly virus. The SafeDose application suite of next generation reference tools standardizes and simplifies the complex process of drug administration. The web-based and mobile-enabled clinical support application provides nurses and physicians with a “peace of mind” double check that dramatically improves patient safety.

In use since 2011, SafeDose Enterprise is used by hundreds of thousands of clinicians every day and has verified millions of medication administration transactions. The web-based application presents the correct information in dosing units (i.e. mg, mcg, units, etc.), by form (ml, tablets, capsules, etc.), by exact weight and by indication. It provides dilution and delivery instructions, adverse reactions, Y-site compatibilities, and appropriate flow charts.

SafeDose Enterprise:

  • Provides a vital double check for accuracy
  • Displays clinical/medication information at a glance
  • Allows you to scan vials for clinical knowledge
  • Exports a time-stamped log to the EMR

SafeDose has proven to:

  • Increase the accuracy of medication doses by 24%
  • Reduce average medication preparation time by 8 minutes per event
  • Enable nurses of all experience levels to prepare accurate medication doses quickly[5]

Double checks to ensure proper dosing is still a critical step to ensure medication administration safety. But that doesn’t mean you have to involve a second nurse to do a manual check and potentially endanger both staff and patients. The technology now exists for a single nurse to perform an accurate double check. It’s time to rethink using it.


[1] Huynh N, Snyder R, Vidal JM, Sharif O, Cai B, Parsons B, Bennett K. Assessment of the Nurse Medication Administration Workflow Process. J Healthc Eng. 2016;2016:6823185. doi: 10.1155/2016/6823185. 

[2] Independent double checks: Worth the effort if used judiciously and properly. Institute for Safe Medication Practices (June 6, 2019).

[3] Westbrook JI, Li L, Raban MZ, Woods A, Koyama AK, Baysari MT, Day RO, McCullagh C, Prgomet M, Mumford V, Dalla-Pozza L, Gazarian M, Gates PJ, Lichtner V, Barclay P, Gardo A, Wiggins M, White L. Associations between double-checking and medication administration errors: a direct observational study of paediatric inpatients. BMJ Qual Saf. 2020 Aug 7:bmjqs-2020-011473. doi: 10.1136/bmjqs-2020-011473.

[4] Dow, W., Lee, K., & Lucia, L. (2020, August 12). Economic and Health Benefits of a PPE Stockpile. Retrieved February 12, 2021, from https://laborcenter.berkeley.edu/economic-and-health-benefits-of-a-ppe-stockpile/

[5] Damhoff HN, Kuhn RJ, Baker-Justice SN. Medication preparation in pediatric emergencies: comparison of a web-based, standard-dose, bar code-enabled system and a traditional approach. J Pediatr Pharmacol Ther. 2014 Jul;19(3):174-81. doi: 10.5863/1551-6776-19.3.174.