Nurse Identified Hospital to Home Medication Discrepancies

Implications for Improving Transitional Care

For older adults with multiple health problems, making the transition from hospital to home is a risky time for medication discrepancies to occur. Medication discrepancies are defined as any difference between the discharge medication list and the medications a patient actually takes once at home.

In this study, nurse interventionists identified and documented medication discrepancies of 101 participants who were discharged from two Inland Northwest hospitals. They found that 94 percent had at least one medication discrepancy with a mean of 3.26 discrepancies per patient. Discrepancies were identified for almost all classes of medications, including those with high safety risks.

The researchers identified more system-level discrepancies (69% of participants) than patient-level ones (40%). System-level discrepancies included incomplete or inaccurate discharge instructions and duplication of medications. Patients took medications not on the discharge list (often due to inaccurate admission medication history) and of different doses at home when compared to the discharge list. Patient-level discrepancies most commonly were intentional nonadherence, including not filling a prescription, sometimes due to cost.

Among recommended evidence-based strategies to reduce medication discrepancies: taking better medication history on admission, educating patients and families about new medication regimes on discharge, and encouraging patients to fill prescriptions as ordered.