Paediatric nurses' understanding of the process and procedure of double-checking medications

J Clin Nurs. 2010 Mar;19(5-6):728-35. doi: 10.1111/j.1365-2702.2009.03130.x.


Aims and objectives: To understand paediatric nurses' understanding and practice regarding double-checking medication and identify facilitators and barriers to the process of independent double-checking (IDC).

Background: A system of double-checking medications has been proposed as a way of minimising medication error particularly in situations involving high-risk medications, complex processes such as calculating doses, or high-risk patient populations such as infants and children. While recommendations have been made in support of IDC in paediatric settings little is known about nursing practice and the facilitators and barriers to this process.

Design: A descriptive qualitative design was used.

Methods: Data were collected via three focus group interviews. Six to seven paediatric nurses participated in homogenous groups based on level of practice. Data were analysed using thematic analysis.

Conclusions: This study demonstrates that, while IDC is accepted and promoted as best practice in a paediatric setting, there is a lack of clarity as to what this means. This study supports other studies in relation to the influence of workload, distraction and environmental factors on the administration process but highlights the need for more research in relation to the impact of the power dynamic between junior and senior nurses. The issue of automaticity has been unexplored in relation to nursing practice but this study indicates that this may have an important influence on how care is delivered to patients.

Relevance to clinical practice: While the focus of this study was in the paediatric setting, the findings have relevance to other settings and population groups. The adoption of IDC in health care settings must have in place: policy and guidelines that clearly define the process of checking, educational support, an environment that supports peer critique and review, well-designed medication areas and accessible resources to support drug administration.

MeSH terms

  • Focus Groups
  • Humans
  • Medication Errors / nursing*
  • Medication Errors / prevention & control*
  • Pediatric Nursing*
  • Safety Management / methods*