INTRODUCTION: Medication errors pose significant risks to patient safety and healthcare quality. This study analyzes the practices of identification and management of these errors in private hospitals in Costa Rica from January 2020 to January 2024. METHODOLOGY: A cross-sectional survey was conducted in four private hospitals, evaluating 167 items related to 11 key drug management processes. In addition, a detailed analysis of retrospective data was carried out at one of the participating hospitals to delve deeper into the nature of the errors. RESULTS: The hospitals presented an overall level of implementation of 74% in the practices evaluated. The prescription and transcription stages were the most vulnerable, while most errors were detected before affecting patients. The drugs involved were mainly of general use and high risk. CONCLUSION: The results highlight the importance of using tools based on international standards adapted to the local context. These help identify areas for improvement, promote preventive strategies, and strengthen patient safety. Applying this approach in other settings could drive standardization and improve outcomes in medication management.