Background Double-checking the administration of controlled drugs has been standard practice worldwide for decades. This process may appear to be a logical safety precaution. However, research has indicated that there is insufficient evidence to support the argument that the process reduces the rate of medication incidents compared to single-checking. The gold standard is independent double-checking meaning both the nurses separately perform a check without sharing information. In practice, this rarely happens: instead, primed double-checking often occurs whereby one nurse shares some information with the other nurse e.g. drug name. Our hospice sought to challenge this longstanding practice by introducing single nurse administration of controlled drugs with the aim to improve promptness in administration and release time to care, whilst maintaining patient safety.
Method We adopted a change management process, starting with an educational session for nurses to explain the rationale for this proposed change. Staff were then assessed in single nurse administration to ensure that they were competent. In order to establish if our aims were met, the administrating nurse recorded the time taken to administer controlled drugs (from identification of need to completion of administration) both before and after single nurse administration was introduced. The balancing measure of patient safety was assessed by reviewing the frequency of controlled drug incidents before and after single nurse administration was introduced.
Results We found a 46% reduction in the mean time taken to administer controlled drugs through single nurse administration compared to double-checking. Furthermore, there was a 25% reduction in controlled drug administration incidents in the first six months of the introduction of single nurse administration compared to double-checking.
Conclusion Through this project we demonstrated that single nurse administration is more time-efficient than, and at least as safe as, double-checking. This project demonstrates successful change management in reinventing long-established nursing administration practice.
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