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Survey results show implementing a medication error reduction plan (MERP) improves safety

ISMP and the California Society of Health-System Pharmacists (CSHP) would like to extend our sincere appreciation to the 226 respondents who completed our survey to better understand how the California Medication Error Reduction Plan (MERP) has impacted medication safety and what people in other states think of the concept. Most respondents were pharmacists (81%), followed by nurses (8%) and pharmacy technicians (8%). We also received responses from other disciplines (3%) including risk managers, hospital administrators, and others. More than half (52%) of the respondents work in states that do not require a MERP, and the remaining work in California (47%) or Arkansas (1%), which requires a MERP through the California Department of Public Health (CDPH) or the Arkansas State Board of Pharmacy, respectively.

California and Arkansas Respondents. More than half (57%) of respondents who work in California and Arkansas have a designated Medication Safety Officer (MSO) or similar position responsible for leading the coordination of their organization’s MERP. Two out of three (66%) did not have an MSO or similar position prior to the MERP requirement, and more than half (52%) told us that the requirement helped justify this position within their organization. In addition, approximately half (51%) of the respondents reported that resources dedicated to medication safety have increased and almost two-thirds (63%) indicated that the requirement helped justify funding for implementing new technologies within their organization.

Nearly three-quarters (72%) of respondents from California and Arkansas believed that patients in their organization are safer in part due to enforcement of the MERP’s legal requirements and that this program has increased awareness of system changes that are needed to prevent medication errors (76%). Overwhelmingly, 84% of organizations use external medication-related error alerts to help identify systems and processes that need to be modified, a recommendation that ISMP has always advocated—taking certain aspects of another’s experience and incorporating it into your own work for the purpose of improvement. In fact, 61% and 51% of respondents indicated that the MERP has increased the number of good catches/close calls and actual medication errors reported, respectively. Even more compelling is that 78% of survey respondents felt that their MERP has reduced harmful medication events. More than three-quarters (76%) of respondents from these two states said that outcomes from MERP initiatives have helped prioritize performance improvements within their medication management system.

We were pleased to see that most organizations (84%) reported that they use a Just Culture process when evaluating and discussing medication errors. Just Culture refers to a values-supportive system of shared accountability where organizations are accountable for the systems they have designed and for responding to the behaviors of their employees in a fair and just manner. Employees, in turn, are accountable for the quality of their choices and for reporting both their errors and system vulnerabilities.1

When asked to describe how enforcement of the MERP’s legal requirements has advanced medication safety in their organization, respondents told us they observed more interdisciplinary collaboration and engagement by upper-level management in medication safety initiatives included in the MERP. To achieve regulatory compliance, the plan’s effectiveness and outcomes receive considerable attention from leadership. One respondent shared that once it became a MERP goal, they were able to accomplish organizational goals that they had difficulty gaining traction on from just a departmental level. While some organizations were initially hesitant about meeting the essential elements of the MERP, respondents told us that the “weight of a regulatory requirement” ensures that the proper stakeholders participate in assessing trends and collaborating on solutions. The MERP program also provides “visibility, voice, and prioritization to medication systems and initiatives.” It should be noted that some respondents shared that they would have a medication safety plan even if it was not mandated.

Other States' Respondents. We were also pleased to hear from those working in 30 other states that currently do not require a MERP. The majority (68%) of respondents were in favor of a regulatory requirement. Some (18%) did not think it should be mandated or expressed concern that a legal requirement could become overly burdensome. Others (14%) were unsure but hopeful it would be effective or were in favor of a voluntary organizational initiative to achieve a similar strategic medication safety plan. Many agreed that requiring a MERP would elevate current safety initiatives, allocate more resources dedicated to medication safety, and would have an overall positive impact on patient safety.

Conclusion. The MERP initiative provides a framework to advance many error-reduction strategies ISMP has advocated for over the years. The survey results support our recommendation for organizations to complete a gap analysis using the California MERP structure and to develop an impactful MERP that focuses on high-leverage systems and technologies. Similar to the California requirement, this comprehensive strategic plan should include a proactive approach to risk analysis, effective and timely use of measurable assessments to evaluate the impact of selective error-reduction strategies, and an annual review to assess the program's effectiveness. We also call for governmental organizations, accreditors, and regulatory agencies (e.g., state departments of health) to adopt initiatives similar to what California has established.  


  1. Outcome Engenuity LLC (2012). Just culture: Training for managers.


Suggested citation:

Institute for Safe Medication Practices (ISMP). Survey results show implementing a medication error reduction plan (MERP) improves safety. ISMP Medication Safety Alert! Acute Care. 2023;28(9):3-4.