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Aims Medication safety is a part of quality of care and patient safety. Old age brings many challenges for safe use of medication. In order to improve the prerequisites of medication safety in acute care of the elderly, we systematically reviewed studies to find out what kind of medication errors happen in elderly acute care. Methods Cinahl, Medline, Cochrane, JBI Connect+ databases and Finnish healthcare databases Medic and Ohtanen were used in the search. The search was performed using both MeSH terms and keywords by the option ‘search all text’. The original keywords were pharmacy or drugs, medical error or deviation and their Finnish synonyms. These keywords were united to the terms elderly, nursing or acute care or intensive care. Studies published between 2001 and 2011 were chosen. Results Medication errors mentioned in the studies were associated with (i) nursing competence, (ii) prescription- and patient-related factors, (iii) medication work organisation and nursing process and (iv) safety culture. This paper presents several practical implications for improving medication safety in the acute care of the elderly. Limitations The grey literature was not included because the authors wanted to limit to the best-quality research. In some studies, elderly acute care was not their exact context or the elderly formed only a part of study population. This may have undermined some types of medication errors typical to elderly acute care. Conclusions To improve the prerequisites of medication, safety in acute care of the elderly management of the medication process should be improved. Also, cooperation within the medical team in making the medical care plans and checking out the medication of the elderly people should be improved. This is an important topic of lifelong education for nurses and other healthcare staff as well. Published by arrangement with John Wiley & Sons.

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