{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T12:57:29Z","timestamp":1792155449711,"version":"4.4.0"},"reference-count":37,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:00:00Z","timestamp":1792108800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:00:00Z","timestamp":1792108800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Nursing in Critical Care"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Intensive care units (ICUs) are high\u2010risk environments where nurses administer the majority of high\u2010alert medications, making them the final checkpoint in the medication\u2010use process. However, evidence on nurse\u2010led interventions specifically targeting high\u2010alert medication errors has not been systematically synthesized across all ICU populations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>This systematic review evaluated the effectiveness of nurse\u2010led interventions in reducing high\u2010alert medication errors in neonatal, paediatric and adult intensive care units and examined implementation strategies that enhance patient safety.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>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\u2010led interventions, measurement of high\u2010alert 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Six studies met the inclusion criteria. Interventions included simulation\u2010based 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%\u2009\u00b1\u20099.2% to 77.7%\u2009\u00b1\u200910.1%), reduced medication dispensing time (to &lt;\u20091\u2009min) and cost savings ($90\u2009000\u2013$130\u2009000 per year). Risk of bias was moderate to low in five studies and high in one study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Nurse\u2010led multicomponent interventions are associated with reductions in high\u2010alert 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Relevance to Clinical Practice<\/jats:title>\n                    <jats:p>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\u2010 to middle\u2010income countries and evaluate long\u2010term sustainability.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/nicc.70747","type":"journal-article","created":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T12:20:28Z","timestamp":1792153228000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Nurse\u2010Led Interventions to Mitigate High\u2010Alert Medication Errors in Critical Care: A Systematic Review of Effectiveness and Implementation Strategies"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-3748-3283","authenticated-orcid":false,"given":"Mobina","family":"Norouzdamghani","sequence":"first","affiliation":[{"name":"Department of Nursing and Midwifery, Se.C Islamic Azad University  Semnan Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-5780-6341","authenticated-orcid":false,"given":"Ghazal","family":"Kasaeian","sequence":"additional","affiliation":[{"name":"Department of Nursing and Midwifery, Se.C Islamic Azad University  Semnan Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yeganeh","family":"Asgharipoor","sequence":"additional","affiliation":[{"name":"Student Research Committee, Sorkhe School of Allied Medical Sciences Semnan University of Medical Sciences  Semnan Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1579-394X","authenticated-orcid":false,"given":"Sajjad","family":"Sadeghi","sequence":"additional","affiliation":[{"name":"Clinical Research Development Unit, Kowsar Educational, Research and Therapeutic Hospital Semnan University of Medical Sciences  Semnan Iran"},{"name":"Food and Drug Research Center, Food and Drug Administration, Ministry of Health and Medical Education  Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,16]]},"reference":[{"issue":"1","key":"e_1_2_13_2_1","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1080\/10376178.2023.2207687","article-title":"The Impact of Nursing Skill\u2010Mix on Adverse Events in Intensive Care: A Single Centre Cohort Study","volume":"59","author":"Ross P.","year":"2023","journal-title":"Contemporary Nurse"},{"issue":"2","key":"e_1_2_13_3_1","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1111\/nicc.12932","article-title":"Medication Administration Error Prevention Among Nurses Working in Intensive Care Units: A Secondary Analysis","volume":"29","author":"Giannetta N.","year":"2024","journal-title":"Nursing in Critical Care"},{"key":"e_1_2_13_4_1","doi-asserted-by":"crossref","DOI":"10.3389\/fpubh.2025.1510147","article-title":"Construction and Validation of a Presenteeism Prediction Model for ICU Nurses in China","volume":"13","author":"Wu J.","year":"2025","journal-title":"Frontiers in Public Health"},{"issue":"12","key":"e_1_2_13_5_1","doi-asserted-by":"crossref","first-page":"917","DOI":"10.5005\/jp-journals-10071-24588","article-title":"Assessment of Medication Safety Incidents Associated With High\u2010Alert Medication Use in Intensive Care Setting: A Clinical Pharmacist Approach","volume":"27","author":"Aradhya P. 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