Medication discrepancies affecting senior patients at hospital admission

This is the authors' abstract. We don't add key points for this paper.

Inconsistencies between patients’ admission orders and home medication regimens may occur.1,–9 The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) recognizes that medication safety is compromised when these discrepancies occur1 and requires hospitals to develop a process for obtaining complete medication histories from patients and documenting, validating, and transferring that information across the continuum of care.2 Currently, there are limited data regarding the type, frequency, and severity of medication discrepancies between the patient’s home regimen and the patient’s admission orders. Gleason et al.8 and Cornish et al.9 have published studies describing the discrepancies that occur when medication histories are obtained by pharmacists and compared with admission orders in the general patient population. No studies specifically investigating the type, frequency, and severity of medication discrepancies for hospitalized senior patients have been published. We conducted a study to identify the type, frequency, and severity of medication discrepancies in the medication histories of and admission orders for senior patients admitted to a medical intermediate care unit (MIMU).