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for the appropriate duration of therapy

with the appropriate monitoring to ensure safety and efficacy of therapy

with the appropriate reporting of adverse drug reactions (Sexton 1999, p. 240).

To achieve this, the nurse must have a sound knowledge of the use, action, usual dose and side-effects of the drugs being administered. Institutional policies and procedures also assist the nurse to administer drugs safely and a sound knowledge of local procedures is essential. Organizational policies therefore need to reflect a culture that encourages disclosure and in which the management of medication errors is viewed as a learning process as opposed to a punitive act (Gladstone 1995, Martin 1994). The NMC states that all errors and incidents require a thorough and careful investigation at a local level, taking full account of the context, circumstances and position of the practitioner involved. Such incidents require a sensitive management and a comprehensive assessment of all the circumstances before a professional and managerial decision is reached on the appropriate way to proceed (NMC 2008a). It must be recognized, however, that errors in drug administration can have traumatic consequences for the individual nurse involved and that disciplinary procedures invoke fear in most nurses (Arndt 1994).

Single or double checking of medicines

Medicines can be prepared and administered by a single qualified nurse or by two nurses checking (known as double checking). There are certain times when double or second checking is required. It is recommended that for the administration of controlled drugs, a secondary signature is required (NMC 2008a). The NMC Standards for Medicines Management also states that ‘wherever possible two registrants should check medication to be administered intravenously, one of whom should also be the registrant who then administers the intravenous medication’ (NMC 2008a, p. 31). Where the administration of a medicine requires complex calculations, it is deemed good practice for a second practitioner (a registered professional) to check the calculation independently to minimize the risk of error (NMC 2008a).

Jarman et al.’s (2002) review of 129 nurses, using questionnaires and reviewing incidents, both during double checking and then once single checking had been introduced, demonstrated no increase in drug errors following the change. Single checking provided satisfaction for nurses and more effective use of time and the nurses felt that single checking allowed them more autonomy and that it was more beneficial to patients and enabled them to be more responsive to their needs. Armitage (2008) suggested that double checking is a common but inconsistent process. Athough often seen to be integral to safe practice, it is often sacrificed when there is a shortage of time or staff (Armitage 2008). He listed the issues with double checking as:

deference to authority

reduction of responsibility

auto processing (familiarity)

lack of time (to check properly)

solutions (how to do it).

A recent study viewed independent double checking as an alternative. This is when two nurses check a drug independently of each other. In this study nurses were observed during the setting up of ambulatory chemotherapy pumps. When compared with the old system of double checking, the new system showed no significantly statistical difference in reducing errors in dose, rate or documentation but did show a reduction in errors related to patient identification (Savage and Tripp 2008).

Those nurses who wish or need to have their administration supervised will retain the right to do so until such time as all parties agree that the requested level of proficiency has been achieved. The nurse checking the medicine must be able to justify any action taken and be accountable for the action taken. This is in keeping with the principles of The Code (NMC 2008b).

Patient identification

Patient misidentification can occur at any stage of a patient’s journey and as it is under-reported, its ‘true’ incidence unknown (Rosenthal 2003). Not