Medication discrepancies at hospital care transitions: associations with nature, types, severity, and drug classes in older adults – A prospective observational cohort study

Background Medication reconciliation (MedRec) improves patient safety by resolving medication discrepancies (MDs). This study examined associations between the nature, type, and severity of MDs, drug categories, and points of identification across care transitions among geriatric patients.Methods A prospective observational study conducted on older adults aged ≥65 years receiving five or more medications were included. MedRec was performed using the World Health Organization High 5s retroactive model. MDs were tracked across all care transitions. The type, severity, nature of MDs, and drug class involved were recorded. Associations were analyzed using Chi-square and Fisher’s exact tests.Results Among 400 geriatric patients, 7739 MDs were observed. Drug interactions were the most frequent discrepancy (55.4%) and were predominantly unintentional (n = 4,294), with most classified as moderate or severe (p < 0.001). Moderate and severe discrepancies occurred significantly more often in unintentional cases (p < 0.001). Most discrepancies occurred during in-patient transfers (67.3%), Unintentional discrepancies were highest in category C (26.08%), whereas intentional discrepancies were more common in category A (3.44%).Conclusion Significant associations observed between the nature, type, and severity of MDs, drug categories, and transitions of care. Study findings suggest the necessity for structured, interdisciplinary MedRec processes during care transitions in geriatric patients to reduce medication-related harm.