RNCohortJournal of the American Medical Directors Association2024

Medication Discrepancies among Older Hospitalized Adults Discharged from Post-Acute Care Facilities to Home.

Eduard Eric Vasilevskis, Silas P Trumbo, Avantika Saraf Shah and 4 others

PMID 38754476

WHAT IT FOUND

One week after home from post-acute care, older adults' medicine lists often did not match what they took: 98% had at least one discrepancy, median 7 per person, mostly omissions.

In a subset, only 6.7% were documented intentional.

Key findings

01At 7-day follow-up after PAC discharge, 98% of participants had at least one medication discrepancy, with a median of 7 discrepancies per person.

02Most discrepancies were omissions: of 1378 total discrepancies, 718 were omissions, 497 were additions, and 163 were dosing discrepancies.

03In a subset of 100 patients with documented provider contact, only 47 of 699 discrepancies (6.7%) were judged intentional.

STILL TO COME

How it was doneWhat they foundWhat it means for RNs

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What it does not show

Only 184 of 372 enrolled patients were analysed, because some died, entered hospice, withdrew consent, were unreachable, or were excluded for long-term care or acute care visits. The sample was mostly white and from an urban setting, so results may not apply to other regions or populations. The 7-day medication list came from patient or surrogate self-report, so recall bias could over- or under-report discrepancies. Intentionality was assessed only in 100 patients with academic health-system provider contact, so most discrepancies had no documented explanation. The risk factor analysis was exploratory and did not link discrepancies to adverse outcomes.

Declared interests

The authors declared no relevant financial or personal conflicts of interest.

The easy way to misread this

Do not conclude that these discrepancies caused adverse events or that a specific medication reconciliation intervention prevents them. The study compared medication lists one week after discharge and did not link discrepancies to patient outcomes.

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