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Double and Triple Prescription Check

Double and triple checking are recommended safety practices in the process of prescribing, preparing, and administering medications, aiming to reduce errors and harm to the patient in the hospital environment. These strategies are part of prevention actions provided by the National Patient Safety Program (PNSP - Brazil) and are aligned with and International Patient Safety Goal number 3 - The World Health Organization (WHO): "Improve safety in prescribing and using medications".

What is Double Check?

Double check consists of the independent verification of critical information by two qualified professionals (usually a nursing technician and a nurse), especially when dealing with high-alert medications (HAM) or high-risk situations. The goal is to detect possible errors before the medication is administered to the patient.

During double and triple checking, professionals should confirm:

  • Correct patient name
  • Correct medication
  • Correct time
  • Correct prescribed dose
  • Correct route of administration
  • Correct record
  • Correct guidance
  • Correct form
  • Correct response

What is Triple Check?

Triple check is a more rigorous procedure that involves checking the medication by three different professionals, usually including a clinical pharmacist or the prescribing physician/attending physician in the final step. Each performs their verification independently and sequentially, ensuring there are no errors at any stage of the process.

It usually occurs as follows:

  • 1st check: performed by the person who retrieves the medication from the pharmacy (nursing technician);
  • 2nd check: performed by the nurse in the unit during preparation together with the nursing technician;
  • 3rd check: performed by a third professional (physician responsible for the prescription/attending physician and/or clinical pharmacist) before administration to the patient. (The third check is not necessarily performed after medication preparation; ideally, the third professional participates in the medication preparation.)

This practice strengthens the safety culture and reduces the occurrence of medication errors. It respects legal standards established by professional councils and observes international patient safety goals #1, #2, and #3.

Priority Indications:

  • Administration of high-alert medications (HAM) (e.g., insulin, heparin, chemotherapeutics, opioids)
  • Medications via infusion pump
  • Complex intravenous preparations, parenteral, including parenteral nutrition (exclusive to nurses)
  • Vulnerable populations (neonates, pediatrics, ICU)

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