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After a 1-month pilot of suspending the dual sign-off/independent double-check process, 160/163 random subQ insulin administrations from various units were administered correctly. This yielded a 98% success rate. No patient harm occured.
Per Institute of Safe Medication Practices, dual sign-offs/independent double-checks are more effective for select high risk meds and not all. Since implementation of the insulin calculator, medication errors related to subQ insulin administration have reduced compared to previously when solely two licensed staff members performed a manual, independent double-check. After implementation of the validated eMAR tool - the insulin calculator - it was still required for two licensed staff members to perform independent double-checks. Due to caring for COVID patients in isolation, nurses observed workaround practices with great variation related to subQ insulin administration and documentation because of this independent double-check requirement. Nurses raised concern for patient safety and workflow efficiencies. A literature review was conducted which revealed support for utilization of the insulin calculator without the need for the additional manual independent double-check/dual sign-off in Epic.
Insulin, Insulin calculator, eMAR, Electronic medication administration record, Electronic health record, Blood glucose
Endocrinology, Diabetes, and Metabolism | Other Nursing
Mondloch, Mallory and Watson, Jennifer, "Suspension of Independent Double-Check for SubQ Insulin Administration" (2021). Nursing Posters. 147.