Nurse-Led Interventions to Mitigate High-Alert Medication Errors in Critical Care: A Systematic Review of Effectiveness and Implementation Strategies.

BACKGROUND

Intensive care units (ICUs) are high-risk environments where nurses administer the majority of high-alert medications, making them the final checkpoint in the medication-use process. However, evidence on nurse-led interventions specifically targeting high-alert medication errors has not been systematically synthesized across all ICU populations.

AIM: This systematic review evaluated the effectiveness of nurse-led interventions in reducing high-alert medication errors in neonatal, paediatric and adult intensive care units and examined implementation strategies that enhance patient safety.

STUDY

DESIGN

We followed PRISMA 2020 guidelines. A comprehensive search was conducted in PubMed, Web of Science and Scopus for studies published between January 2000 and June 2026. Inclusion criteria required nurse-led interventions, measurement of high-alert medication error rates and critical care settings. The risk of bias was assessed. A narrative synthesis was performed due to heterogeneity in study designs and outcome measures.

RESULTS

Six studies met the inclusion criteria. Interventions included simulation-based training, staff education, smart pump integration, clinical decision support systems and standardization of medication orders and protocols. All studies reported improvements in medication safety outcomes, including reductions in medication error rates, improved compliance, enhanced accuracy and increased efficiency. Secondary outcomes included improved compliance with PRN orders (from 62.0% ± 9.2% to 77.7% ± 10.1%), reduced medication dispensing time (to < 1 min) and cost savings ($90 000-$130 000 per year). Risk of bias was moderate to low in five studies and high in one study.

CONCLUSION

Nurse-led multicomponent interventions are associated with reductions in high-alert medication errors and improvements in safety outcomes in critical care settings. However, technology alone is insufficient without workflow integration and nursing education. Education and standardization require concurrent process redesign for sustained improvement.

RELEVANCE TO CLINICAL PRACTICE: Nurses should advocate for multicomponent strategies combining training, technology and standardized protocols. Healthcare organizations must ensure workflow integration to maximize the benefits of smart pumps and clinical decision support systems. Future research should employ rigorous designs, include diverse ICU settings and low- to middle-income countries and evaluate long-term sustainability.