Effect of an educational intervention on double signature check strategy to reduce chemotherapy medication incidents at Mbarara regional referral hospital, Uganda

Abstract BackgroundChemotherapy medication incidents are a major patient safety concern, especially in resource-constrained settings, due to the complexity, high toxicity, and narrow therapeutic indices of anticancer agents. The double signature check strategy requiring verification by two qualified healthcare professionals is a widely recommended safety measure to minimize the risk of errors in chemotherapy prescribing, preparation, and administration. Despite its importance, adherence to this practice remains suboptimal in many institutions. This study evaluated the effect of an educational intervention on the use of a double signature check strategy to reduce chemotherapy medication incidents among health workers at MRRH.MethodsA quasi-experimental study was conducted at MRRH oncology unit involving oncology healthcare providers, including medical doctors, nurses and pharmacists engaged in chemotherapy services. The intervention comprised structured training sessions, distribution of standard operating procedures (SOPs), and continuous reminders emphasizing the importance of the double signature check to ensure accuracy and patient safety. Data on chemotherapy medication incidents and compliance with the double-check procedure were collected for three months pre-intervention and three months post-intervention using incident reporting forms and direct observation tools. Chemotherapy incidents were evaluated in 113 patient records (cycles one and two), compared with baseline data (47.3%). Wilcoxon rank tests assessed changes in knowledge/perceptions, and two-proportion z-tests compared error rates.ResultsPost-intervention adherence to the double signature check significantly improved from 45–85% (p < 0.05). Concurrently, chemotherapy medication incidents decreased from 15 cases pre-intervention to 5 cases post-intervention. Prescription and administration errors reduced significantly by 17% (p = 0.002) and 23.7% (p < 0.001), respectively.ConclusionThe educational intervention substantially enhanced compliance with the double signature check strategy and reduced chemotherapy medication incidents. The double-check process serves as a critical barrier against errors in high-risk medications like chemotherapy, reinforcing the need for ongoing staff education and adherence monitoring to maintain patient safety.