Nursing in critical care · 2026
Nursing Mechanisms of Intravenous Medication Loss in Adult Intensive Care: A Mixed-Methods Systematic Review.
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Liang Lijun, Xu Jinlong, Hu Yang, Zhang Pingwen
Аннотация
BACKGROUND: Adult ICU medication loss is reported using non-equivalent forms and denominators, limiting interpretation and intervention design.
AIMS: To examine loss measurement, nursing mechanisms, intervention evidence and balancing outcomes.
STUDY DESIGN: Convergent segregated mixed-methods systematic review. Three databases were searched to 1 July 2026, with citation searching, metadata checks and an uncapped rerun of two capped PubMed arms. Quantitative results remained in native units; qualitative findings were synthesised separately and integrated. MMAT 2018 was applied by design category; two reviewers checked screening, extraction and appraisal.
RESULTS: Of 768 screened records (576 primary; 192 rerun), 79 reports were assessed with retained sources. Four reports could not be retrieved. Twenty-five reports from 21 independent studies were included; the rerun added none. Categories were prepared-unused medication (11), post-order or post-event loss (7), partial-container residual (8), delivery-system residual (3) and material-flow loss (4); categories were nonexclusive. Denominators were explicit in 10 studies, partial in 5 and absent in 6. No studies met pooling criteria. Two qualitative studies generated six low-confidence CERQual findings. Intervention evidence was uncontrolled, modelled or proposal-based; balancing outcomes were uncommon.
CONCLUSIONS: Adult ICU loss comprised non-equivalent quantities, not one waste prevalence, and no study related it to a patient outcome. Studies would need to specify loss form, numerator, denominator, observation window, workflow node, result origin and balancing outcomes alongside resource use.
RELEVANCE TO CLINICAL PRACTICE: Order review before non-urgent preparation, reconstitution and checking, storage and return pathways, and syringe, pump and line handling are candidate targets; no controlled adult ICU study has shown reduced loss without affecting access, dose delivery, sterility, compatibility or workload.
AIMS: To examine loss measurement, nursing mechanisms, intervention evidence and balancing outcomes.
STUDY DESIGN: Convergent segregated mixed-methods systematic review. Three databases were searched to 1 July 2026, with citation searching, metadata checks and an uncapped rerun of two capped PubMed arms. Quantitative results remained in native units; qualitative findings were synthesised separately and integrated. MMAT 2018 was applied by design category; two reviewers checked screening, extraction and appraisal.
RESULTS: Of 768 screened records (576 primary; 192 rerun), 79 reports were assessed with retained sources. Four reports could not be retrieved. Twenty-five reports from 21 independent studies were included; the rerun added none. Categories were prepared-unused medication (11), post-order or post-event loss (7), partial-container residual (8), delivery-system residual (3) and material-flow loss (4); categories were nonexclusive. Denominators were explicit in 10 studies, partial in 5 and absent in 6. No studies met pooling criteria. Two qualitative studies generated six low-confidence CERQual findings. Intervention evidence was uncontrolled, modelled or proposal-based; balancing outcomes were uncommon.
CONCLUSIONS: Adult ICU loss comprised non-equivalent quantities, not one waste prevalence, and no study related it to a patient outcome. Studies would need to specify loss form, numerator, denominator, observation window, workflow node, result origin and balancing outcomes alongside resource use.
RELEVANCE TO CLINICAL PRACTICE: Order review before non-urgent preparation, reconstitution and checking, storage and return pathways, and syringe, pump and line handling are candidate targets; no controlled adult ICU study has shown reduced loss without affecting access, dose delivery, sterility, compatibility or workload.