The purpose of this study is to better understand outpatient prescribing errors through clinic and pharmacy-based error reporting systems.

Medication errors cause substantial morbidity and mortality in the United States. However, relatively little is known about medication errors in the outpatient setting. The broad goal of this proposal is to improve outpatient safety. Specifically, this research plan promotes the understanding of the causes of outpatient prescription errors. The specific aims of this project are:

1. To develop and evaluate a novel reporting system in physicians' offices for detecting prescription errors
2. To develop and evaluate a novel improvement system in community pharmacies to increase prescription error reporting by pharmacists
3. To analyze reports of outpatient prescription errors and understand their root causes

To achieve these specific aims, statewide research will be conducted utilizing qualitative and quantitative methods including root cause analysis, failure mode and effects analysis, and surveys. This research plan will promote patient safety by furthering the understanding of the causes of outpatient prescription errors in all outpatient populations, including rural, women, children, elderly, low income, and the chronically ill.

Inclusion Criteria:

• Employed in a physician's office or community pharmacy

Exclusion Criteria:

• Not employed in a physician's office or community pharmacy

Primary Care Practices