+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Identifying opportunities to improve medication management in transitions of care



Identifying opportunities to improve medication management in transitions of care



AmericanJournalofHealth-SystemPharmacy72(17Suppl2):S58



The types and causes of medication discrepancies during the transition from inpatient to ambulatory care were investigated. 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. 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. 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.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 058043238

Download citation: RISBibTeXText

PMID: 26272894

DOI: 10.2146/ajhp150059


Related references

Identifying opportunities to improve the management of care: a population-based diagnostic methodology. Journal of Ambulatory Care Management 20(2): 18-32, 1997

Identifying risk factors for adverse drug events in intensive care unit provides actionable opportunities to customize medication management*. Critical Care Medicine 40(3): 998-999, 2012

Cost-related medication underuse: Strategies to improve medication adherence at care transitions. American Journal of Health-System Pharmacy 76(8): 560-565, 2019

Transitions of Care for Stroke Patients: Opportunities to Improve Outcomes. Circulation. Cardiovascular Quality and Outcomes 8(6 Suppl 3): S190, 2015

Experience with technology-supported transitions of care to improve medication use. Journal of the American Pharmacists Association 56(5): 568-572, 2016

Engineering a Foundation for Partnership to Improve Medication Safety during Care Transitions. Journal of Patient Safety and Risk Management 24(1): 30-36, 2019

Extubation and reintubation in the NICU: identifying opportunities to improve care. Pediatric Nursing 18(3): 267-270, 1992

Smooth Sailing in Advanced Illness Transitions of Care: Optimizing Medication Management from Palliative Care to Hospice Care (P05). Journal of Pain and Symptom Management 51(2): 308-309, 2016

Safety threats and opportunities to improve interfacility care transitions: insights from patients and family members. Patient Preference and Adherence 6: 711-718, 2012

Identifying Opportunities to Improve Intimate Partner Violence Screening in a Primary Care System. Family Medicine 50(9): 702-705, 2018

Facilitated Nurse Medication-Related Event Reporting to Improve Medication Management Quality and Safety in Intensive Care Units. Nursing Research 66(5): 337-349, 2017

Identifying opportunities to improve clinical outcomes for hypertensive patients with diabetes in a managed care setting. American Journal of Hypertension 13(4 Part 2): 260A, 2000

Identifying Opportunities to Reduce Cost and Improve Patient Care in the Routine Processing of Urine Samples. American Journal of Clinical Pathology 149(Suppl_1): S26-S27, 2018

Identifying opportunities to improve management of autoimmune hepatitis: evaluation of drug adherence and psychosocial factors. Journal of Hepatology 57(6): 1299-1304, 2012

Impact of pharmacist-led medication management in care transitions. Bmc Health Services Research 17(1): 722, 2017