Key result
Transitioning from inpatient to outpatient care in 17 high-risk patients was associated with 96 medication discrepancies, of which 68% involved the omission of a prescribed medication.
Observational (n=17)
No
Medication discrepancies are highly prevalent during transitions from inpatient to outpatient care, with cardiovascular medications frequently involved.
May guide quality improvement in care transitions; leaves open whether addressing discrepancies improves clinical outcomes.
PURPOSE: The types and causes of medication discrepancies during the transition from inpatient to ambulatory care were investigated. METHODS: A descriptive study was conducted at an academic outpatient group practice affiliated with a private nonacademic hospital to (1) describe discrepancies between inpatient discharge summaries and patient-reported medication lists, (2) identify patient and system factors related to breakdowns in medication documentation, and (3) determine reasons for medication discrepancies. During a four-month period, 17 patients at high risk for medication misadventures while transitioning from hospital care to outpatient follow-up were contacted by telephone soon after discharge and asked to provide information on all medications they were taking. Patient-reported medication lists were compared with the corresponding discharge summaries, and medication discrepancies were categorized by patient- and system-level factors using a validated instrument. RESULTS: Of the total of 96 discrepancies identified, more than two thirds (n = 67, 68%) involved the omission of a prescribed medication from either the patient-reported list or the discharge summary. Cardiovascular medications, including antihypertensives, antilipemics, diuretics, and antiarrhythmics, accounted for almost one quarter of all medication discrepancies. About 15% (n = 14) and 16% (n = 15) of identified discrepancies related to medication dose and frequency, respectively. CONCLUSION: Among 17 patients transitioning from inpatient to outpatient care, nearly 100 discrepancies between patient-reported medication lists and discharge summaries were identified. Most discrepancies were attributed to nonintentional nonadherence and resumption of home medications without instructions to do so. All 17 patients had at least 1 medication discrepancy categorized as involving a system-level factor.
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Downes et al. (2015) conducted an observational in Medication discrepancies during transitions of care (n=17). Transition from inpatient to ambulatory care was evaluated on Medication discrepancies between inpatient discharge summaries and patient-reported medication lists. Transitioning from inpatient to outpatient care in 17 high-risk patients was associated with 96 medication discrepancies, of which 68% involved the omission of a prescribed medication.
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