Safety Culture in Medication Administration among Nurses in Asia Systematic Literature Review

ABSTRACT Background: Medication administration safety among nurses is closely influenced by workplace safety culture across Asian healthcare settings. This systematic literature review analyzed 36 peer-reviewed studies to identify research trends, key themes, and gaps. The findings show that supportive leadership, teamwork, and open, non-punitive reporting environments are linked with safer medication practices. Common barriers include hierarchical structures, fear of blame, and heavy workload. More context-specific strategies and deeper research are needed to improve medication safety in Asia. Purpose: Examine existing research on safety culture in medication administration among nurses in Asia, identify key research trends and collaboration patterns, and determine theoretical, empirical, methodological, and practice-related gaps to guide future research and practice. Methods: A structured search was carried out using databases including ScienceDirect, Scopus, PubMed, and Google Scholar. Thirty-six English peer-reviewed articles met the inclusion criteria. Bibliometric analysis and VOSviewer mapping were used to explore trends, authors, journals, countries, and collaboration networks, while thematic narrative synthesis was used to interpret the findings. Results: The findings indicate a growing research interest in safety culture and medication administration among nurses in Asia, with a strong emphasis on quantitative studies and systematic literature reviews. Research output was unevenly distributed across Asian countries, and qualitative and longitudinal studies were limited. Positive safety culture—characterized by leadership support, effective communication, teamwork, and non-punitive error reporting—was consistently associated with safer medication practices. However, hierarchical structures, fear of blame, high workload, and staffing shortages were frequently identified as barriers to effective safety culture implementation. Value: The review provides a comprehensive synthesis of current evidence on safety culture in medication administration among nurses in Asia and highlights critical gaps that need to be addressed. The findings offer valuable insights for nurse leaders, healthcare organizations, and policymakers to develop context- specific strategies aimed at strengthening safety culture, improving medication safety practices, and enhancing patient outcomes. Additionally, the review establishes a foundation for future research to advance theory, methodology, and practice in medication safety within Asian healthcare systems Keywords: Safety culture; Medication administration; Nurses; Patient safety; Medication errors; Asia; Systematic literature review; Bibliometric analysis