Standardized Videos on the Double-Check Process Aims to Help Nurses Administer High-Alert Medications

Stephanie Jackson DNP, MSN, RN, AOCNS, BMTCN

Minimizing errors for high-alert medications such as chemotherapies may be achieved with interventions such as standardized educational videos on double-check policies, according to findings from an evidence-based strategy presented at the 48th Oncology Nursing Society Annual Congress.

After conducting a survey assessment on knowledge regarding proper handling of high-alert medications and finding gaps in knowledge, a standardized video was created to help nurses better understand the Institute of Safe Medication Practices recommendations.

Of nurses who were surveyed (n = 29), 27.6% reported they did not think concentration of the drug administered needed to be checked. Additionally, 20.7% did not think tubing should be traced from the medication bag to the patient. Following the implementation of an educational video, awareness of tracing increased by 4.9%. Regarding other components of the independent double-check, 93.1% of nurses or greater gave correct responses in the pre-survey on double-check factors including patient name, MRN, medication name, dose, route, rate, and programming the pump.

“We know that with any implementation of something new is sustainability. That’s the hardest part. We can all learn something new, but being able to sustain it [is the challenge],” Stephanie Jackson DNP, MSN, RN, AOCNS, BMTCN, said in an interview with Oncology Nursing News®following the presentation.

Findings from a literature review indicated that most medication errors occur because of ineffective communication, Jackson and coauthors cited in their poster. Using the Institute for Safe Medication Practices checklist, investigators at UCLA Medical Center hypothesized that an improvement in the detection of medication/prescription errors would be observed. Eighty-one pre-intervention, high-risk audits were performed from August 2022 to November 2022. Two errors were reported, which included an intravenous compatibility issue with continuous intravenous immunosuppressive drugs as well as incorrect patient-controlled analgesia pump programming. Ongoing monitoring is underway for postintervention findings.

“We will continue to do audits—our charge nurses will be doing the audits. We want to make sure that we continue these practices even as we see the transition of our new nurses becoming more competent and proficient,” Jackson explained. “[We] also [want to] make sure that the nurses coming behind them will have access to that same information, so we’ve put our video on a platform that is visible at any time to all nurses who are working.”

Jackson, the unit director for the hematology/stem cell transplantation unit at Ronald Reagan UCLA Medical Center, detailed the implications of the surveys and the reviewed double-check process.

Oncology Nursing News: What led to the development of this study?

Jackson: We have 5 generations [of nurses working] in our inpatient oncology unit and we noticed varying knowledge of chemotherapy [administration] and the implications for safety. This project was birthed out of seeing that gap in knowledge among our novice nurses to experts and we decided to conduct a baseline knowledge assessment to see what they knew about the requirements for an independent verification of high-alert drugs.

Based on that we created a video that included all the necessary components of the independent verification—the right treatment plan, medications being ordered, dose, concentration, route, and also making sure that once that drug is connected to the patient that it’s given over the right amount of time. Based on that once we conducted this video, we decided that we would do a postknowledge assessment after approximately 3 to 4 weeks of implementation.

We surveyed 60% of our nursing staff and based on the baseline knowledge we identified a gap was [with] the concentration of the drug. The nurses didn’t know that they were also responsible for knowing that. The other piece that they didn’t know is that they were responsible for not only connecting the drug and starting the drug, but also verifying that that drug was connected to the patient.

What did the video consist of?

We taped [the video] in the unit, and it went from the time you get an order in the electronic medical record [to] what should be independently verified by nurses. Based on the patient’s diagnosis, are they getting the right treatment plan? [Once the] treatment plan that the provider has dictated is verified by pharmacy, it’s visible to the nurse; at that point, 2 nurses are independently sitting down looking at the computer separately to verify the drugs, route, days that the drug is being administered, time of infusion, and making sure it’s ordered for the appropriate amount of days.

Once you have verified the drug is correct and the regimen is correct, both nurses go into the room and do the same thing in front of the patient. [When] the primary nurse hangs the drug, makes sure that it’s connected to the patient, the pump is set correctly, and it’s going to drip appropriately, that is also verified by the second nurse.

What did you find surprising after implementing the video?

[the findings were] powerful because what surprised us is that we assumed all our nurses had the knowledge. The online chemotherapy course through the Oncology Nursing Society is comprehensive, it’s 15 continuing education units, [and] we felt that the knowledge and the validation of skills that we have on the unit was sufficient. It was surprising to know that even the newer nurses lacked all the components that were necessary for the independent verification.

What are the overall implications of this study for oncology nursing?

I would say it’s being the best that we can be for our patients. They deserve that, we heard that from keynote speaker [Maimah Karmo, cancer survivor and founder and CEO of the TigerLily Foundation], that those are the things [patients] never forget. Yes, they want us to have the knowledge we need [to] be competent, but [they want us] also to be present and to talk about things they may not feel comfortable talking about with the doctors, other individuals who come into the room, or even their family. They look to nurses. It’s a reason we’re the most trusted profession and we owe it to our patients to have not only the knowledge, but the presence.

Reference

Chung J, Chave RV, Jackson S, Wheatley T. Standardizing the independent double check process to reduce medication errors on an inpatient oncology unit. Poster presented at: 48th Annual Oncology Nursing Society Congress; April 26-30, 2023; San Antonio, TX. Accessed May 9, 2023. https://ons.confex.com/ons/2023/meetingapp.cgi/Paper/12838