The Third Consensus Development Conference on the Safety of Intravenous Drug Delivery Systems convened in 2018 to evaluate the progress of intravenous (IV) drug safety since the 2009 conference. This review summarizes guideline changes regarding compounded sterile preparations (CSPs), new legislation, recommended best practices, workflow automation, and the impact of drug shortages. At the conference, the two most significant threats to IV drug safety were drug shortages and lack of standardization. The panel developed 10 overarching statements regarding safe IV drug safety including developing and strengthening a culture of safety.