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Nursing in critical care
By Liang L, Xu J, Hu Y and 1 others.
Adult ICU medication loss is reported using non-equivalent forms and denominators, limiting interpretation and intervention design.
To examine loss measurement, nursing mechanisms, intervention evidence and balancing outcomes.
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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.
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.
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.
Published in Nursing in critical care. The abstract is shown as published and remains the work of its authors; read the full article at the source.
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