Remote verification methods through virtual care nurse models and telehealth technologies have merit, but the evidence is inadequate to determine safety or efficacy, according to the latest findings from a team of ONS members and staff that were published in the Clinical Journal of Oncology Nursing.

An independent double check (IDC) can reduce the risk of hazardous medication errors. On-site IDC of high-risk medication by two nurses is the standard of administration, but current staffing shortages have led to barriers and delays. Responding to the ever-evolving healthcare landscape, ONS commissioned the nurse research team to use an evidence-based approach to review literature and trends for remote independent verification of high-risk medications.

Researchers used the PICO (problem, intervention, comparison, outcome) format to generate keywords from the inquiry, “In patients requiring chemotherapy or high-risk medications, how does an in-person double check compare to a virtual second observer double check affect errors?” In addition to reviewing current literature, the researchers consulted the ONS Communities online discussion boards to obtain evidence and assess processes in the real clinical environment from 2019–2023. They also conducted practice interviews with some of the individuals from the ONS Communities. After synthesizing the literature and practice interviews, they established two themes: use of “video virtual (remote) technology” and “technology-assisted workflow systems.”

They found that the use of remote verification technologies such as telephone and video call were common and “there were no associated errors in documentation or safety when a remote pharmacist, in addition to a second verifier on site, completed the IDC.” Safety risks to remote IDC remain a concern, however, including potential barriers to remote verification and inspection of the infusion pump and drug label in video calls as well as to infusion rate check, confirmation of drug label accuracy, and visual inspection of the product to be administered in telephone verification.

 “Evidence suggests virtual technology for two-person IDCs is feasible and may be equal to live two-person checks; however, lack of consistency and rigor in the interventions and outcome measures prevents determining safety or efficacy at this time,” the researchers concluded. Although only a few institutions are incorporating technology into the IDC process, many individuals expressed interest in this innovation, likely as a result of critical nursing shortages and an increasing volume of patients with cancer.

Learn more about remote IDCs in the full Clinical Journal of Oncology Nursing article.