DESCRIPTION (applicant's abstract): The care of residents and their quality of life within the nursing home setting remains a concern despite many efforts aimed at improvement (IOM, 2001). Recent concerns have been raised about the inherent dangers of aging in a nursing home setting. The projected growth in the elder population suggests that improving the quality of nursing home care will continue to be a priority. With 35 percent of the population expected to be 65 years and older by 2020, the number of nursing home residents is expected to increase (Gregory et al., 2002). As this population continues to increase, efforts to reduce inherent dangers such as medication error are critical to the well-being of this vulnerable population. It is not known how often unexpectedly poor response to treatment could be due to undetected omission of a medication or receipt of a wrong dose. Research suggests that medication errors average 10 percent or more of administered doses, excluding wrong time errors (Allan and Barker, 1990; Barker and Allan, 1995). In addition to large numbers of undetected medication errors, even relatively minor discrepancies in medication may negatively affect outcomes of vulnerable populations such as elderly in the nursing home setting (Bates et al., 1995; GAO, 1999; Medicare Payment Advisory Commission, 1999; Mitchell et al., 1988). Hence, implementation of evidence-based solutions to improve medication safety practices is a priority. The purpose of the study is to evaluate the use of bedside technology (One Touch eMAR System) and QIPMO (Quality Improvement Program for Missouri's Long-Term Care Facilities-QIPMO) to improve medication safety practices within the nursing home setting as a companion study to a technology study currently funded by the U.S. Center for Medicare and Medicaid Services (CMS). The study would explicitly explore the impact of the One Touch eMAR System and QIPMO upon improving medication safety and related quality improvement processes within the nursing home setting. The specific aims of the study are to: 1) determine baseline medication safety practices (order entry, alerts to prevent adverse drug event and special medication precautions, resident identification, and dispensing) in the nursing home setting; 2) evaluate the One Touch eMAR System and QIPMO in the nursing home setting as they relate to reduction of adverse drug events and medication error rates; 3) elicit the organizational and individual barriers to safe medication practices within the nursing home setting; 4) assess the nursing home culture through the use of the Competing Values Framework to determine organizational readiness to embrace innovation and new quality improvement strategies; and 5) explore the costs of medication administration and error in the nursing home setting. [unreadable] [unreadable]