Is independent double-checking superior to single-checking in medication administration error detection? A randomised controlled simulation trial (13 March 2026)

Summary

Double-checking of medication administration is a safety practice used in hospitals around the world. Independence is recommended as the key to effectiveness. Independent double-checking (IDC) requires each nurse to separately check the five rights (eg, right drug, dose). There is no empirical evidence that IDC is more effective in error detection than a single-nurse check.

The aim of this study was to compare the effectiveness of IDC versus single-checking in detecting medication errors during administration, assess the time required and explore factors influencing performance, including nurse experience and social dynamics.

It found that IDC improved error detection for experienced nurses, but not for early career nurses. Given its inconsistent benefits, resource demands and susceptibility to social loafing (defined as reduced individual performance when working in pairs), IDC may be unsuitable as a universal safety strategy. Strengthening single-checking competence and supporting clinical judgement may offer a more effective, scalable approach to improving medication safety.