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1/17/2013 5:00 PM

​​Research study validates web-based tool for independent double check

Dosing errors are the most common type of paediatric drug errors, with over-dose out numbering under-dose errors. Morphine is the high-alert drug most frequently administered in error, due to distractions, interruptions and high stress that are a common occurrence in a busy clinical environment.  Paediatric drug calculations are typically weight-based and nurses administering medications ascertain the accuracy and appropriateness of the dose using the patient’s weight.  An independent double check (IDC) where two nurses independently verify the patient, medication, drug concentration, dose, time and route can help to detect and avert medication errors at the point-of-care. Despite these measures there continues to be a significant number of patient safety incidents related to medication causing harm to paediatric patients.

A research study supported and funded by the Canadian Patient Safety Institute, the University of Ottawa School of Nursing and Sandoz International, Preventing Medication Errors with High Alert Drugs: Testing a Computerized Double Check, looked at the utility and usability of a web-based tool called the iDoseCheck for preventing morphine dosing errors, as compared to the standard paper, pencil, calculator double check. The iDoseCheck is a graphical calculator developed to assist nurses with the IDC. The iDoseCheck aids in verification of both the mg/kg dose and the volume of morphine to be administered.  The web-based tool displays strategically placed error messages to provide information about over- and under-dosing.

“The independent double check is often an interruption for the checker, even though it is intended to detect and avert medication errors,” says Dr. Jacqueline Ellis, Children’s Hospital of Eastern Ontario (CHEO) and lead of the study, Preventing Medication Errors with High Alert Drugs: Testing a Computerized Double Check.  “With so many distractions and interruptions in our day-to-day work, medication errors can and do happen.  The iDoseCheck is a useful visual tool that will help to keep our patients and nurses safe.”

The iDoseCheck was developed collaboratively by nursing, pharmacy, information technology and human factors engineering professionals. The application was tested in the University of Ottawa, Nursing Simulation Lab, at the Canadian Association of Pediatric Health Centres annual conference and at CHEO, on a post-operative care unit and an emergency department.  Participants in the research study included 112 nurses, 29 nursing students, 13 hospital administrators, two pharmacists, two physicians and one physiotherapist.

“The study participants found the iDoseCheck easy to learn with minimal training,” adds Dr. Ellis.  “The iDoseCheck was preferred over the usual paper, pencil, calculator method of dose calculation and nurses were confident that it was accurate and provided them with one more check in the process of preparing and administering IV bolus morphine.”   

Dr. Ellis cautions that the iDoseCheck is not a substitute for drug calculations, rather an additional method to check the accuracy of the calculation.

At this time the web-based tool provides calculations for 2 mg of intravenous morphine only, however, screens are being developed to include 5 and 10 mg of intravenous morphine. Further developments under consideration include 11 other opioids, rapid sequence intubation medications and paediatric resuscitation medications.  A mobile application will also be developed to provide access to calculation support at the point-of-care.

Click on the link to access a copy of the Preventing Medication Errors with High Alert Drugs: Testing a Computerized Double Check report, , or visit www.patientsafetyinstitute.ca and click on Research to learn more about the study.  To view a demonstration of the web-based tool, visit www.idosecheck.com