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| 1. |  Book/Report: Keeping Patients Safe: Transforming the Work Environment of Nurses. |
| | Committee on the Work Environment for Nurses and Patient Safety, Board on Health Care Services, Page A, ed. Washington, DC: National Academies Press; 2004. |
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| 2. | Study: The health care cost of drug-related morbidity and mortality in nursing facilities. |
| | Bootman JL, Harrison DL, Cox E. Arch Intern Med. 1997;157:2089-2096. |
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| 3. | Study: Care homes' use of medicines study: prevalence, causes and potential harm of medication errors in care homes for older people. |
| | Barber ND, Alldred DP, Raynor DK, et al. Qual Saf Health Care. 2009;18:341-346. |
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| 4. | Study: Nurse–physician communication in the long-term care setting: perceived barriers and impact on patient safety. |
| | Tjia J, Mazor KM, Field T, Meterko V, Spenard A, Gurwitz JH. J Patient Saf. 2009;5:145-152. |
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| 5. | Study: Nurses' perceptions of safety culture in long-term care settings. |
| | Wagner LM, Capezuti E, Rice JC. J Nurs Scholarsh. 2009;41:184-192. |
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| 6. | Study: Improving medication error reporting in hospice care. |
| | Boyer R, McPherson ML, Deshpande G, Smith SW. Am J Hosp Palliat Care. 2009;26:361-367. |
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| 7. | Study: Medication discrepancies upon hospital to skilled nursing facility transitions. |
| | Tjia J, Bonner A, Briesacher BA, McGee S, Terrill E, Miller K. J Gen Intern Med. 2009;24:630-635. |
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| 8. | Study: Prescribing discrepancies likely to cause adverse drug events after patient transfer. |
| | Boockvar KS, Liu S, Goldstein N, Nebeker J, Siu A, Fried T. Qual Saf Health Care. 2009;18:32-36. |
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| 9. | Study: Effect of computerized provider order entry with clinical decision support on adverse drug events in the long-term care setting. |
| | Gurwitz JH, Field TS, Rochon P, et al. J Am Geriatr Soc. 2008;56:2225-2233. |
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| 10. | Study: Does error and adverse event reporting by physicians and nurses differ? |
| | Rowin EJ, Lucier D, Pauker SG, et al. Jt Comm J Qual Patient Saf. 2008;34:537-545. |
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| 11. | Study: Clinical outcomes of a home-based medication reconciliation program after discharge from a skilled nursing facility. |
| | Delate T, Chester EA, Stubbings TW, Barnes CA. Pharmacotherapy. 2008;28:444-452. |
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| 12. | Study: Preventing medication errors in long-term care: results and evaluation of a large scale web-based error reporting system. |
| | Pierson S, Hansen R, Greene S, Williams C, Akers R, Jonsson M, Carey T. Qual Saf Health Care. 2007;16:297-302. |
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| 13. | Study: The safety of warfarin therapy in the nursing home setting. |
| | Gurwitz JH, Field TS, Radford MJ, et al. Am J Med. 2007;120:539-544. |
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| 14. | Book/Report: Adverse Health Events in Minnesota: Third Annual Public Report. |
| | St. Paul, MN: Minnesota Department of Health; January 2007. |
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| 15. | Study: Hospitalization and death associated with potentially inappropriate medication prescriptions among elderly nursing home residents. |
| | Lau DT, Kasper JD, Potter DE, Lyles A, Bennett RG. Arch Intern Med. 2005;165:68-74. |
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| 16. | Study: Nurses' and nursing assistants' perceptions of patient safety culture in nursing homes. |
| | Hughes CM, Lapane KL. Int J Qual Health Care. 2006;18:281-286. |
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| 17. | Study: Multidisciplinary medication review in nursing home residents: what are the most significant drug-related problems? The Bergen District Nursing Home (BEDNURS) study. |
| | Ruths S, Straand J, Nygaard HA. Qual Saf Health Care. 2003;12:176-180. |
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| 18. | Government Resource: Centers for Medicare and Medicaid Services (CMS) Nursing Home Compare. |
| | Centers for Medicare and Medicaid Services. |
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| 19. | Multi-use Website: Missouri Center for Patient Safety. |
| | c/o Primaris, 200 North Keene Street, Columbia, MO 65201. Phone: 800-735-6776. |
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| 20. | Newspaper/Magazine Article: Approved: 2010 National Patient Safety Goals. |
| | Jt Comm Perspect. October 2009;29:1, 20-31. |
