The checking methods before medication administration: A perspective from a Joint Commission International–accredited academic medical center hospital in China

We read with great interest the study by Hewitt et al, which concentrated on weaknesses in double checking and alternative ways to view the practice based on semistructured interviews of health care practitioners. We especially appreciate the research methodology and design of this creative work. We are from the Second Affiliated Hospital of Zhejiang University (SAHZU), a Joint Commission International (JCI)– accredited academic medical center hospital with 3200 beds in China. We would like to share our perspectives in the following paragraphs. First, the study by Hewitt et al confirmed the variability in interpretations and ideas of what constitutes a double check among front line health care practitioners, and this finding indicated that practitioners should need to clarify what is meant by double checking. Actually, there are four expressions of checking strategies in clinical practice, including single checking, single‐person double checking, double‐person checking, and independent double checking (IDC). An institution should specify the scope of implementing each checking method. According to the Institute for Safe Medication Practices, IDC means that the second practitioner independently verifies whether the item (eg, dosage) is correct and the answer is then compared with the first practitioner's results. The lack of collaboration is intended to eliminate the bias that would be generated if the two practitioners jointly arrived at an answer.When conducted properly, IDC could catch 95% of errors, leaving only a 5% chance of an error being missed. Second, IDC should only be used for very selective high‐alert medications because of workload issues looming heavily over practitioners. JCI implementation on managing the safe use of concentrated electrolytes recommends IDC policy for correct product, dosage, method of delivery, dilution, and patient before intravenous administration. Barras et al described the implementation of safety systems for the use of intravenous potassium chloride. After the introduction of intervention measures that included IDC at point of administration, the number of incidents significantly reduced from 23 to 9 in the 12months (P < .001). Since January 2013, our hospital has required a standardized IDC before barcode‐assisted medication administration of special high‐alert medications (eg, intravenous insulin, intravenous heparin, chemotherapy medications, and narcotics), ie, before administering medication, two licensed healthcare professionals independently go