TABLE 4.

Conclusions and Recommendations Presented by the Authors of the Included Studies (n = 46)

Process Stage	Key Conclusions and Recommendations
Prescribing (n = 8)	A standard order form increases order completeness and reduces prescribing errors and patient harm.44,60
	Online calculators improve prescribing in complex dosing policies (e.g., obese and pediatric patients)46,52 and eliminate high-risk errors.52
	A customized alert significantly decreased inappropriate prescribing, but providers may abandon an appropriate prescription in response to an alert.70
	CPOE- and CDSS-generated resuscitation orders are legible, complete, automatically checked for accuracy, and completed in less time.56
	When a pharmacist is present, patients are more likely to receive appropriate doses of antimicrobials and in a more timely fashion.47
	A multidisciplinary approach involving simple interventions resulted in improved physician prescribing behavior.45
Dispensing (n = 1)	CPOE orders saved pharmacists’ time and improved the safety of processing continuous infusions, although not all errors were eliminated.53
Preparation (n = 6)	Compounding workflow software systems (e.g., barcode scanning, gravimetric weighing of components, and real-time images of process steps) improve detection of preparation errors.54,55
	Centralized, automated preparation of standardized infusion solutions may be an effective means for reducing clinically relevant deviations in concentration conformity of infusion solutions.48
	Providing drug infusions in syringes prefilled by pharmacists or pharmaceutical companies would reduce medication errors and treatment delays.49
	Calculation errors can disappear with good standardization protocols, but a decrease in accuracy error depends on good preparation techniques and environmental factors.50
	A tabletop EPS device demonstrated sensitivity and specificity in validating the identity and concentrations of high-risk IV medications and may help prevent medication errors caused by inaccurate compounding.71
Administration (n = 24)	Smart pumps reduce but do not completely prevent pump programming errors.24,40,58,62–66 High override rates of soft limits and insufficient compliance in drug library use limit the effectiveness.24,42,51,63,64,66,67 Hard limits play a main role in intercepting errors.24,66 Opportunities for improvement include integrating smart pumps with barcode readers and CPOE real-time clinical data (e.g., glucose control and respiratory monitoring).24,51,62–66 Smart pumps allowing automated relays of vasoactive infusion pumps reduce hemodynamic incidents.58
	Color-coded systems such as prefilled syringes,39 pediatric weight zones,36 and labels37 decrease time to medication administration36,37,39 and reduce pediatric errors36,39 and wrong fluid errors37 in simulated emergency situations.
	Anesthesia safety systems including drug trays and trolley, prefilled syringes, color-coded labels, barcode drug verification, and administration record and safety alarms reduce medication errors35,43 and adverse outcomes.43
	Administration of incompatible drugs in intensive care can be reduced by procedural interventions with standard operating procedure.68,69
	Checklists designed with explicit step-by-step instructions are useful for detecting errors when a care provider is required to perform a long series of mechanistic tasks under a high cognitive load.33
	Standardization of high-risk medication use (e.g., validated algorithms for extravasation prevention in pediatric peripheral chemotherapy) can enhance patient safety by establishing rapid intervention and proper follow-up.73
	The use of CPOE-generated orders for continuous infusions saved nurses’ time and improved user satisfaction but did not decrease the incidence of medication errors associated with verification of infusion pump settings.57
	Barcode scanning is more feasible than 2-person confirmation when verifying use of the right drug.72
	A calculator to convert orders to volumes and administration rates improved nurses’ performance in drug calculations during simulated clinical scenarios.34 Interventions can reduce unanticipated errors of commission in medication administration tasks when interruptions occur, but effectiveness at reducing predictable errors of detection in medication verification tasks is mixed.32
Treatment monitoring (n = 2)	Integrating a computer-based insulin protocol into a CPOE system achieved efficient, safe, and effective glycemia control in surgical intensive care unit patients.74
	The use of a CPOE set improved treatment monitoring when prescribing IV haloperidol (e.g., electrocardiogram and electrolyte monitoring) and reduced the proportion of subjects who received haloperidol >2 mg/24 h.75
Standardization of a high-risk medication use process (n = 5)	Technology (CPOE, CDSS, PCA smart pumps)59 and safety interventions (e.g., standardized orders, education, and independent manual double checks)41 decrease PCA-related medication errors.
	Use of an easily applied intervention increased the amount of IV fluid administered to patients receiving acyclovir, a potentially nephrotoxic medication.76
	In a simulated environment, a computerized protocol for tight glycemic control resulted in significant insulin dosing error reduction, saved time and improved nurse satisfaction.38
	A multifactorial approach to the safe prescribing, dispensing, and administration of IV potassium reduced the potential for patient harm.61

CDSS, clinical decision support system; EPS, enhanced photoemission spectroscopy; PCA, patient-controlled analgesia.