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GETTING TO THE ROOT OF THE PROBLEM
Studies over the years have established and reestablished the same undeniable fact: medication errors present an alarming and persistent danger within medicine. The challenge to the health care field has been to move beyond this reality to arrive at fundamental solutions to identify the underlying causes for medication errors and to develop strategies for improving systems.

In 1999 a strategic partnership was established among the American Hospital Association, the Health Research and Educational Trust, and the Institute for Safe Medication Practices (ISMP). Supported by the Commonwealth Fund, the Pathways for Medication Safety® initiative set out “to create nonpunitive, system-based approaches to reduce adverse events and errors in hospitals.”