Which Features of Medication Double-Check Procedures are Considered Desirable and Implemented in Practice? A Cross-Sectional Web-Based Vignette Study among Nurses in Japan

Objective Nurses' specific medication-administration double-check procedures vary widely; while independent double-checks (IDCs) are considered effective and recommended, they are implemented insufficiently in practice. This study aimed to classify these procedures by their component features and determine which features nurses consider desirable and perceive as implemented in clinical practice. Design Cross-sectional web-based vignette study Setting, participants, and methods Nurses working in Japanese hospitals or clinics participated in this study, for which we created 84 scenarios by combining checking procedures' features, including independence between checkers, across the calculation, preparation, and administration stages. For each scenario, participants self-reported the desirability of the procedure and its perceived implementation frequency in their clinical setting. Linear mixed-effects models assessed associations between checking-procedure features and each rating, and McNemar's test assessed discrepancies between desirability and implementation frequency for IDC. Primary outcome Associations between double-check procedures' features and their desirability and implementation frequency, and the alignment between desirability and implementation frequency for IDC Results Of 534 respondents, 265 were analyzed after prespecified attention-check exclusions. Independent checking was positively associated with desirability (b=0.304, 95% CI [0.255, 0.353], p<0.001), perceived implementation frequency for high-risk medications (b=0.140, 95% CI [0.080, 0.200], p<0.001), and non-high-risk medications (b=0.083, 95% CI [0.022, 0.143], p=0.008). Only 22.5% of nurses perceived IDC as the most frequently implemented procedure during the calculation stage. Moreover, 23.4% rated IDC as the most desirable, but did not report it as the most frequently implemented, whereas 8.1% showed the reverse pattern (OR=2.89, 95% CI [1.69, 4.94], p<0.001). Conclusions Although independence, a key feature of IDC, was reflected in nurses' desirability ratings and perceived implementation frequency, IDC was not the most frequently implemented checking procedure, relative to others. Implementing IDC may require not only promoting understanding of its significance but also establishing work protocols and organizational environments that enable independent checking.