Medication prescribing checklists and their impact on patient safety: A scoping review

Medication prescribing checklists and the impact on patient safety remain unexplored.

This scoping review aimed to identify key elements of these checklists and evaluate their impact on patient safety outcomes.

We searched PubMed and Embase for studies reporting checklists in medication prescribing practices and the impact on patient safety outcomes as of October 23, 2024. We applied Fisher's exact test to evaluate the association between checklist effectiveness (based on patient safety outcomes) with study design (randomized controlled trials [RCTs] vs non-RCTs) and intervention type (bundled intervention vs checklist-only intervention).

After full-text review, 53 articles met inclusion criteria for data extraction and analysis, including 4 (7.5%) RCTs, 25 (47.2%) quasi-experimental designs, and 24 (45.3%) observational studies. Medication prescribing checklists commonly include elements such as prescription accuracy, drug interaction checks, education, and adherence to guidelines. Twenty-nine (54.7%) studies assessed checklist effectiveness, including 11 with bundled intervention and 18 with checklist-only intervention. Among the 29 effectiveness studies, 25 (86.2%) found the checklist to be effective (23 quasi-experiment studies, one retrospective study, and one RCT), while 4 (13.8%) reported no benefit or inferior outcomes. Barriers to implementation include usability and clinical workflow integration. Notably, studies without an RCT design were more likely to be effective (P = 0.004). The likelihood of effectiveness was not significantly different between studies implementing checklists as part of a bundled intervention and studies with checklists as a single implementation strategy (P = 0.622).

Checklists are an effective tool in improving the safety of medication prescribing practices. However, checklist effectiveness is potentially influenced by several factors such as usability and integration into the workflow. RCTs were more likely to find checklists to be ineffective than non-RCTs. Further research is necessary to confirm checklist effectiveness and refine their design and implementation strategies.