EFFECT OF A MEDICATION SAFETY DOUBLE-CHECK PROTOCOL ON HIGH-ALERT MEDICATION ADMINISTRATION PRACTICES AMONG EMERGENCY NURSES: A QUASI-EXPERIMENTAL STUDY

Abstract

Background: High-alert medications (HAMs) carry an elevated risk of severe patient harm when administered in error, and the emergency department (ED) is a clinical environment where time pressure, overcrowding, and frequent interruptions amplify this risk (Nguyen et al., 2024). Independent double-checking (IDC) is widely endorsed as a safety barrier, yet adherence among emergency nurses remains inconsistent.

Aim: To evaluate the effect of a structured medication safety double-check protocol on HAM administration practicesspecifically adherence to IDC, HAM administration error rates, and nurses' perceived barriersamong emergency nurses.

Methods: A quasi-experimental pre–post design with a non-equivalent comparison group was conducted over 12 months (January–December 2025) in two EDs of a tertiary care hospital. The intervention comprised a standardized IDC protocol, a visual "safety pause" cue, targeted education, and weekly audit-and-feedback. Data were collected through direct observation of HAM administrations (n = 412 pre-intervention; n = 438 post-intervention), incident reports, and a validated barriers questionnaire (Lau et al., 2026).

Results: IDC adherence increased from 34.2% (141/412) pre-intervention to 78.5% (344/438) post-intervention (χ² = 168.4, p < 0.001; φ = 0.45). The observed HAM administration error rate declined from 18.9 per 1,000 administrations to 6.8 per 1,000 administrations (rate ratio 0.36, 95% CI 0.21–0.62). Perceived time pressure as a barrier decreased from 81.3% to 52.1% (p < 0.001).

Conclusion: A multicomponent double-check protocol substantially improved IDC adherence and reduced HAM administration errors in the ED, though residual barriers related to staffing and workflow persist. The protocol offers a feasible, low-cost safety intervention for high-risk emergency care settings