Stephanie Jackson on Improving the Double Verification Process For High-Alert Medications


Stephanie Jackson, DNP, MSN, RN, AOCNS, BMTCN, highlights how her unit leveraged an educational video to improve compliance with double verification for high-alert medications.

Standardized videos can help nurses clearly understand and visualize the components of the double-check process for high-alert medications, according to Stephanie Jackson, DNP, MSN, RN, AOCNS, BMTCN.

Jackson, who is unit director for the hematology/stem cell transplantation unit at Ronald Reagan UCLA Medical Center, coauthored a quality improvement project, the findings of which were presented in a poster during the 48th Annual Oncology Nursing Society (ONS) Congress. The findings of the intervention demonstrated that using these standardized videos helped increased the number of nurses who knew to trace tube medication from the IV bag to the patient by 4.9%.

ONS and the Institute of Safe Medication Practices categorize chemotherapy and other oncology agents as high-alert medications. Although safeguards exist to reduce errors throughout the drug delivery process, mistakes still occur with these medications. The independent verification and double check process are effective methods to minimize medication errors; however, prior to the study, a survey demonstrated that 27.6% of nurse respondents (n = 29) did not know that they needed to check the concentration of the drugs and 20.7% did not understand that the tubing should be traced from the medication bag to the patient.

The goal behind this project, therefore, was to disseminate best practices and develop the double-check process in an inpatient hematology/oncology unit. The nurse leaders developed an educational video which demonstrated the correct steps of the verification process in accordance with the institutional guidelines and shared it with their staff in December 2022.

Prior the rolling out the video, the leaders issued a knowledge assessment to gather baseline data. Findings were compared with outcomes from a post video knowledge assessment that was issued to nurses who completed the educational video.

Audits were conducted to determine the number of mistakes occurring with high-alert medications prior to the intervention. Across 81 audits performed on the day and night shifts between August to November 2022, 2 errors were confirmed.

Postintervention audits are ongoing, and Jackson is optimistic about the impact of the project.

“The next step is sustainability,” she said. “That’s the hardest part. We can all learn something new, but [we need to] be able to sustain it. So, we will continue to do audits [because] we want to make sure that we continue these practices, even as we see our new nurses become more competent and proficient.”


Chung J, Chave RV, Jackson S, Wheatley T. Standardizing the independent double check process to reduce medication errors on an inpatient oncology unit. Poster presented at: 48th Annual Oncology Nursing Society Congress; April 26-30, 2023; San Antonio, TX. Accessed April 28, 2023.

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