Single and Safe Intervention for MEDication administration (SaSI-MEDs): The development and evaluation of an intervention to de-implement unnecessary double-checking of medicines in hospital

Medication errors are one of the most ubiquitous patient safety problems in modern healthcare, with 237 million errors occurring annually in England. Errors at the point of administration account for over half of this total.

One strategy to reduce these errors in hospitals is the double-checking of medicines by two nurses before administration to patients. A recent systematic review found that double-checking did not reduce medication-related harm. Despite this, double-checking is still commonly used and required by all hospital policies in England.

Double-checking also incurs a significant opportunity cost (6.4mins of nurse time per check) and can actually contribute to patient harm (delays in critical medicines and increased patient safety incidents).

Little is known about double-checking practice in the UK and there has been no rigorous evaluation of strategies to withdraw it.

It is not surprising then that in 2022 NHS England stated that knowing whether 'double-checking medication reduces errors' was a national research priority. Our research programme will address this evidence gap.

We are well-positioned as a multidisciplinary team of experts (in patient safety, pharmacy and nursing), methodologists, behavioural scientists and lay leaders to tackle the challenge of de-implementing double-checking.

Our engagement with NHS patients and staff over the past year confirms de-implementation as a priority for healthcare research. Our overall aim is to determine if reducing double-checking of medicines saves money without harming patients.

In this 5-year programme we will: Use a range of methods, including observation, interviews and documentary analysis, to understand barriers and levers to reducing double-checking of medicines in English hospitals (Work Package 1a).

Build on WP1a, a review of nursing related causes of medication errors and the behavioural and safety science literature to co-produce with patients and NHS staff a complex intervention to reduce double-checking of medicines whilst enhancing the safety of single-checking (WP1b) Describe how double-checking is currently carried out via brief observations of (1000+) nurse double-checks and identify the type and extent of administration errors (WP2).

We will also define and investigate the frequency and extent of critical delays to medicines associated with double-checks and reported medication administration errors with and without harm to inform economic modelling.

Conduct a non-randomised representative feasibility study to determine if and how the complex intervention is delivered in practice and what needs to change to support its implementation across different types of services (WP3).

We will also evaluate the processes for collecting observational data, questionnaire data and accessing and analysing routine data.

Undertake a randomised wait-list controlled trial to establish if stopping double-checking of medicines in hospital is non-inferior in terms of medication administration errors and patient harm and is superior in terms of reducing nursing costs and delays in medication administration (WP4a). Our parallel process evaluation will explore how, when and in what circumstances the intervention works (WP4b).

We will work with stakeholders over the course of the programme to inform, shape and share our research findings (WP5). Patients and NHS staff have, and will continue to, input via staff and patient advisory groups.