Background Errors have been reported to occur in 19% of drug administrations in children.1 Double checking of medicines by two nurses is one strategy used by many children's hospitals to attempt to prevent errors from reaching patients.2 There is insufficient evidence to either support or refute the effectiveness of double checking in reducing errors.3 This study aimed to examine whether single or double checking, is more effective in detecting and reducing medication errors in children, and to compare the time required for each process.

Materials and methods A simulation study of paediatric nurses administering medicines was conducted in a UK children's hospital. Each participant was required to prepare and administer medicines in scenarios for two “patients” in a pair with another nurse (as double check) and alone (as single check). The scenarios varied sufficiently to act as an independent test. One to three confounders (including prescribing errors and drugs which were contraindicated) were built into each of the 4 scenarios (cases) for nurses to identify and address during the administration process. Errors in drug preparation and administration and failure to address confounders were documented by the investigator.

Results 21 nurses participated. 49/76 (64%) confounders were detected during single checking. 37/42 (88%) confounders were detected during double checking. The difference was statistically significant (P=0.0136) with double checking being more likely to identify errors and contraindicated drugs than single checking. Five preparation/administration errors were made by participants: 4 during single and 1 during double checking. The time taken for drug administration was similar for both processes.

Conclusion Double checking appears to be more effective in detecting and reducing errors than single checking in paediatric drug administration. This should improve patient safety.