Assessing ward system changes to mitigate medication administration errors: A comprehensive systematic review of interventional studies

Background and aim: Medication administration errors are any deviation from the medication order specified by the prescriber on the patient's chart, specifically relating to the process of administering the medication to the patient. It is estimated that between 18.7% and 56% of all adverse events in hospitalised patients are attributable to preventable medication errors. The aim of this review was to assess the efficacy of nursing staff based ward system change interventions to reduce MAEs in in-patient settings. 
Methods: This review adhered to PRISMA guidelines and conducted an electronic search across PubMed, Scopus, Embase, and Cochrane Library using keywords related to nursing interventions and medication administration errors. The search, limited to English-language records, excluded commentaries, editorials, and non-research articles. After screening titles and abstracts, we included randomised and non-randomized clinical trials and other interventional studies focused on ward-based system changes for reducing medication administration errors. Studies involving educational or technology-based interventions, simulations, or observational methods were excluded, as were those with incomplete data on Medication administration errors. Data extraction covered study details, intervention types, and impacts on Medication administration errors reduction.
Results: Out of 655 initial records, 46 were screened, and nine studies were included in the review. Most studies (five) were from the USA, with durations from 2 to 47 months, and focused mainly on single institutions. Key findings include: reduction in IV infusion errors through standardisation of doses and training; improved medication accuracy via safety processes and leadership training; a 52% reduction in Adverse Drug Events with quality improvements; however, mixed results with a "Safe Zone" protocol; decreased MAEs by 56.4% with comprehensive bundles of interventions; no significant change was found with recall cards and cross-checking; 90% compliance was achieved with two-person verification for infusion pumps, reducing errors; error rates were cut by over 56% with multiple improvements; and no significant impact was shown with "Do not interrupt" vests.
Conclusion: The evidence supporting interventions aimed at reducing medication administration errors (MAEs) in hospital settings is limited. However, significant improvements in MAE rates have been observed with ward system change interventions. These findings should be approached with caution, as many studies did not employ optimal study designs or data collection methods, and were subject to potential bias.