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Implementing Independent Double Check: Safeguarding Insulin Administration for Patient Safety

Authors
Martey, Marteki
Date
2025-05
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DNP Project
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IDC OF INSULIN ADMINISTRATION
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Abstract

Problem: A large research institution identified a rise in insulin administration errors, primarily due to the absence of an Independent Double Check (IDC) protocol. From January to September 2023, 60 omission errors were recorded, highlighting deficiencies in structured IDC procedures, competency assessments, and documentation protocols. Despite institutional policies for other high-risk medications, insulin lacked a standardized verification process. Purpose: This Quality Improvement (QI) project aimed to reduce insulin omission errors and enhance documentation adherence by implementing an IDC process with mandatory co-signer verification in one adult medical oncology unit and one stem cell transplant unit. Method: The project spanned 15 weeks in Fall 2024, beginning with a structured education phase for nursing staff on IDC procedures and co-signer documentation. IDC compliance was monitored through weekly chart audits, which evaluate insulin administration, co-signature adherence, and documentation accuracy. Strategies such as huddle reminders, email reinforcements, and visual aids supported sustained engagement. Results: Initial compliance rates were 83%, with a decline to 77% by week four. Reinforcement strategies improved compliance to 98% by week nine, demonstrating a positive result. Although 100% documentation adherence was not consistently achieved, no omission errors occurred, and all insulin doses were correctly administered without adverse events. Challenges included fluctuating staff engagement, workflow inconsistencies, and documentation gaps. Conclusion Implementing an IDC process significantly improved compliance and eliminated omission errors, reinforcing its role in enhancing patient safety. To sustain this project leadership will need continue to reinforce and integration of hard-stop compliance features within the electronic Medication Administration Record (eMAR). The findings support broader institutional adoption of IDC protocols to improve medication safety.

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