Oncology nurses' beliefs and attitudes towards the double-check of chemotherapy medications: a cross-sectional survey study

• Published in: BMC health services research Vol. 18; no. 1; p. 123
• Main Authors: Schwappach, D L B, Taxis, Katja, Pfeiffer, Yvonne
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 17.02.2018; BioMed Central; BMC
• Subjects: Adult; Antimitotic agents; Antineoplastic agents; Antineoplastic Agents - administration & dosage; Attitude of Health Personnel; Attitudes; Beliefs, opinions and attitudes; Cancer; Chemotherapy; Cross-Sectional Studies; Dosage and administration; Double-check; Drug administration; Drug therapy; Error correction & detection; Female; Health aspects; Health services; Humans; Male; Medical errors; Medical Oncology; Medical research; Medication errors; Medication Errors - nursing; Medication Errors - prevention & control; Middle Aged; Nurses; Nursing Staff - psychology; Oncology; Patient safety; Patients; Pharmacy; Practice; Professionals; Regression Analysis; Safety and security measures; Survey; Surveys; Surveys and Questionnaires; Switzerland; Patient safety; Oncology; Double-check; Survey; Medication errors
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/s12913-018-2937-9

Double-checking medications is a widely used strategy to enhance safe medication administration in oncology, but there is little evidence to support its effectiveness. The proliferated use of double-checking may be explained by positive attitudes towards checking among nurses. This study investigated oncology nurses' beliefs towards double-checking medication, its relation to beliefs about safety and the influence of nurses' level of experience and proximity to clinical care. This was a survey of all oncology nurses in three Swiss hospitals. The questionnaire contained 41 items on 6 domains. Responses were recorded using a 7-point Likert scale. Multiple regression analysis was used to identify factors linked to strong beliefs in the effectiveness of double-checking. Overall, 274 (70%) out of 389 nurses responded (91% female, mean age 37 (standard deviation = 10)). Nurses reported very strong beliefs in the effectiveness and utility of double-checking. They were also confident about their own performance in double-checking. Nurses widely believed that double checking produced safety (e.g., 86% believed errors of individuals could be intercepted with double-checks). In contrast, some limitations of double-checking were also recognized, e.g., 33% of nurses reported that double checking caused frequent interruptions and 28% reported that double-checking was done superficially in their unit. Regression analysis revealed that beliefs in effectiveness of double-checking were mainly associated with beliefs in safety production (p < 0.001). Nurses with experience in barcode scanning held less strong beliefs in effectiveness of double-checking (p = 0.006). In contrast to our expectations, there were no differences in beliefs between any professional sub-groups. The widespread and strong believe in the effectiveness of double-checking is linked to beliefs about safety production and co-exists with acknowledgement of the major disadvantages of double-checking by humans. These results are important factors to consider when any existing procedures are adapted or new checking procedures are implemented.