Small rural hospitals (SRHs) lack adequate resources to develop independent structures to collect, report, and analyze data on medication errors. This project works to overcome those and other barriers by creating a collaborative relationship between SRHs and a university-based group. The long-range goal of this research project is to establish an ongoing practice of medication error reporting, feedback and analysis, and action in SRHs. The objective of this intervention is to implement the patient safety practices of voluntary medication error reporting and organizational learning to improve the safety of medication use in SRHs. This intervention builds on preliminary data from a three-year collaboration between the quality improvement staff of an academic medical center, a national medication error reporting program, and SRHs in Nebraska to develop a program of medication error reporting, feedback, analysis, and system change to improve medication safety. Guided by this preliminary data, the project has 3 aims: (1) Develop the organizational [unreadable] infrastructure for reporting, providing timely feedback, and analyzing medication errors within participating SRHs necessary to identify and implement evidence-based practices that minimize the latent system causes of these errors. During the intervention, a medication safety toolkit will be constructed. (2) Evaluate the effectiveness and sustainability of the CAH medication safety toolkit within participating hospitals. The sustainability of this intervention will be assessed by monitoring the activities of the original 15 participating hospitals during the second year of the project, when they will not be receiving resources from this grant. (3) Disseminate the results of the project, in collaboration with AHRQ, to audiences positioned to modify policies and/or implement the intervention. The toolkit and related project policy briefs and papers will be available to others via heavily used Web sites for distribution to their constituents. This project is innovative because it uses the precepts of action research, an effective means of both enriching the researchers' understanding of the barriers to implementing an effective system of medication error reporting in SRHs, and rapidly translating research into practice. The outcome of this research will be significant because it will yield change [unreadable] in patient care that improves patient safety for an AHRQ priority population in over 1,500 rural communities. This research is relevant to public health because it has the potential to influence the overall health care system to provide a safer and more effective use of medications by implementing a medication error and organizational learning strategy that identifies and incorporates systematic risks with process solutions. The active integration of system analysis, a medication safety toolkit, and the dissemination of findings creates the opportunity to reduce the risk of injuries due to medication error and increase the quality of care to patients [unreadable] [unreadable]