To evaluate the evidence for double checking the administration of medicines.
systematic search of six electronic databases-Embase, Medline, British
Nursing Index and Archive, CINAHL, National electronic library for Medicines
(NeLM) and PsycINFO-for all articles describing double checking of medication
and dose calculation, for either dispensing or administration in both adults
and children up to and including October 2010.
Sixteen articles met the inclusion criteria. There were only three
quantitative studies. Only one of these was a randomised controlled clinical
trial in a clinical setting. This study showed a statistically significant
reduction in the medication error rate from 2.98 (95% CI 2.45 to 3.51) to
2.12 (95% CI 1.69 to 2.55) per 1000 medications administered with double
checking. One study reported a reduction in dispensing errors, by a hospital
pharmacy, from 9.8 to 6 per year following the introduction of double
checking. The majority of the studies were qualitative and involved
interviews, focus groups and questionnaires.
There is insufficient evidence to either support or refute the practice of
double checking the administration of medicines. Clinical trials are needed
to establish whether double checking medicines are effective in reducing