Medication Discrepancy

Accurate medication documentation is a critical step in safe care transitions. When a patient is admitted to the hospital, a member or members of the healthcare team must identify the patient’s current home medication regimen. This process is called medication reconciliation and should be done at every transition of care (Peinado, Silveira, Vargas, & Vicedo, 2016). Incomplete or inaccurate medication documentation can be harmful if a physician orders the wrong type of medication or if a chronic medication is omitted from the orders. These are examples of medication discrepancies. When two or more medication lists are compared, a medication discrepancy is detected if there is an inconsistency between the lists regarding the medication

If a chronic medication is not documented on admission, a patient may have negative effects during the hospitalization since the medication was not continued. Antiepileptics, antiarrhythmics, and antidiabetic medications are medications that must be resumed to prevent an adverse event that could jeopardize a patient’s safety. Many adverse events related to medications occur after discharge (Corbett et al., 2014). Patients are twice as likely to be readmitted if there are medication discrepancies present at discharge (Corbett et

970). During a study of individuals treated for hypertension at free clinics, inaccurate medication documentation was related to a notably elevated risk of uncontrolled blood pressure (Downes et al., 2015). On more than one occasion, patients with congestive heart failure are readmitted to the cardiac care unit at Shawnee Mission Medical Center because a necessary diuretic was not included on the discharge medication list. Patients admitted for bradycardia or hypotension related to multiple cardiovascular medications must provide an accurate list of home medications to determine which medications contributed to the condition. If these medications are not recognized on admission or during hospitalization, they will not be addressed during the discharge process. If the medications go unmentioned, patients will go home and continue to take the medications that may have caused the original hospitalization (Downes et al.). Decreasing preventable hospital readmissions is a nationwide priority concerning patient safety and efficient use of healthcare resources (Corbett et al.,