Double Pharmacist Check

[Sparda29]

Hey guys, just wondering if your hospital also uses the double pharmacist check? Isn't this excessive? My old community hospital didn't do it, but the academic pediatric medical center does.

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[Dred Pirate]

we do it on certain higher risk items
IV chemotherapy
NICU TPN's
and NICU meds

I have no issues with it - we do cath potential errors at times

Most hopitals I know do have a small list of meds that require double RPh's checks

 

[awval999]

IV chemo and NICU tpns

 

[bacillus1]

We only do it for chemo. The chemo pharmacist verifies the order, then when the IV label is printed out, the IV room pharmacist double-checks the calculations. It is time consuming, but I have found several calculation mistakes while floating to the IV room.

To be fair, we have no peds whatsoever at our hospital, so no clue what's done for peds.

 

[njac]

I saw a 10x pediatric clonidine iatrogenic overdose due to a lack of pediatric double check as a resident.


Current hospital does double-check on order entry and again on dispensing.

Ditto for chemo.

 

[SELDANE]

we always did it for NICU, PICU, and TPN's

 

[Sparda29]

I would admit though, without the double check procedure, we'd probably end up with less staffing. Right now we have somewhere from 10-12 pharmacists 7am-3pm, 3 more from 12pm-8pm, 3 more from 3pm-11pm, and then 3-4 from 930p-7am.

 

[OmiPharmD]

We have a double pharmacist check on pediatric IVs and also high risk meds for all patients such as chemotherapy.

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[Dalteparin]

We have double pharmacist check on chemo and NICU TPNs.

 

[confettiflyer]

If you count it the way njac does it, every order is checked once at computer/order entry verification, and again at product vs. label dispensing check by pharmacy.

We double check at the dispensing point: All IV NICU meds
--> For IV compounded NICU meds, 1 RPh checks all of the components first (after being drawn up into a syringe, then once more after being compounded to ensure volume/qualitative checks).
--> So if you count the order verification point, NICU orders are checked three times before leaving.
--> For PO/premixed NICU meds going into an ADC, it is exempt from our tech-check-tech program and must be checked by a pharmacist. So this constitutes a single RPh check prior to dispense.

We double check at the order entry point: All TPN and chemotherapy orders (these are all still paper).

 

[BidingMyTime]

It sounds like a very good idea, although I've never worked in a place that did it. Many safety-critical areas (such as engineering) have double checks of calculations. All humans make mistakes, and a mistake in a child is much more likely to have a deleterious effect, so having double checks is a superb idea. Especially on an IV, unlike an oral drug, there wouldn't be a nurse double check on the IV.

 

[KidPharmD]

At our major pediatric medical center we do the following double checks...

Any smart pharmacist can catch certain checks because Order entry checks (CPOE) is usually a different pharmacist than the one checking the filled med. IV's are checked for approximate volume/concentration calculations at fill check.

We have a list of high risk meds that have to be double checked. Anticoagulants, Insulin, anything that is a small enough volume to go into an insulin syringe, etc.

We also have nursing double checks on these high risk meds plus opiates.

We absolutely catch errors on double check on a regular basis.

 

[mustang sally]

Hey guys, just wondering if your hospital also uses the double pharmacist check? Isn't this excessive? My old community hospital didn't do it, but the academic pediatric medical center does.

What types of orders do you have to double check? Everything or just certain items?

It is our protocol to do it for chemo. But most of the pharmacists here also ask for a double check on pediatric meds, just because we don't have a lot of pediatric patients and want to be careful.

 

[confettiflyer]

But most of the pharmacists here also ask for a double check on pediatric meds, just because we don't have a lot of pediatric patients and want to be careful.

I've requested double checks at the verification level on complex orders involving peds (rarely adults). It's usually an unusual med/dose/administration issue.

 

[Sparda29]

What types of orders do you have to double check? Everything or just certain items?

It is our protocol to do it for chemo. But most of the pharmacists here also ask for a double check on pediatric meds, just because we don't have a lot of pediatric patients and want to be careful.

The verification is done by one person. Label prints out, tech fills order, 2 pharmacists have to check what the tech filled on all drugs.

 

[confettiflyer]

The verification is done by one person. Label prints out, tech fills order, 2 pharmacists have to check what the tech filled on all drugs.

This is the dumbest thing I've ever heard.

 

[Sparda29]

My main problem at the pediatric hospital I'm at right now (I love it here) but my methods/habits from my job at the adult hospital are messing me up here. They told me to unlearn everything I learned at the adult hospital except for the CPOE system which is the same. I'm used to working alone a lot during the evening shift where speed verification becomes a priority/habit. I'm so tempted to just casually scan through the order checking to see where the usual numbers are correct and verifying it.

During a sim lab, this method potentially caused a death. I read the order as D5 1/2 NS w/ 60 mEQ K+ @10 mL/hr. I assumed that all IV bags are made in 1L bags. I forgot to read that part of the order, which instead read as 250 mL size (meaning 240 mEQ/L in a 10 kg kid).

Other issues, my old hospital didn't even follow the USP 797 rules. You go to the stock room, grab your products, walk into the IV room, go into the hood and make IV. No one garbs up, just gloves. (Maybe a hand wash before the gloves, but unlikely.) You don't even log the products used.

This place does USP 797 rules even though the room is not 797 compliant. And there is extensive logging to be done on all IV and PO compounds prepared.

 

[DrWrong]

We, like other have stated, do it with Chemotherapy. In fact, I believe those orders actually get triple checked. 2 times with EPIC Beacon and then again within the IV center.

 

[owlegrad]

That would have been tough to blame on the nurses.

 

[confettiflyer]

My main problem at the pediatric hospital

Okay ignore my last reply, wasn't aware of this. I thought you were still at your ******* hospital.

 

[KARM12]

Peds is a high risk area - especially in an academic peds hospital. You probably see more specialized dosing/medications where this becomes important.

 

[Sparda29]

Peds is a high risk area - especially in an academic peds hospital. You probably see more specialized dosing/medications where this becomes important.

Yeah, they want us to check Lexi-Comp and the hospital Med Use Manual before verifying anything when we're training. I'll admit, I could verify a complete patient profile of 10-20 meds in the adult hospital in less than 5 minutes. It probably takes me 5-10 minutes to verify one peds order.

 

[njac]

Yeah, they want us to check Lexi-Comp and the hospital Med Use Manual before verifying anything when we're training. I'll admit, I could verify a complete patient profile of 10-20 meds in the adult hospital in less than 5 minutes. It probably takes me 5-10 minutes to verify one peds order.

Good.

It's not a bad thing to slow down.

I still double-check myself on pediatric doses that I use every single day.

You'll also get faster at the Lexi-comp part as you get used to doing it.