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Medication discrepancies identified at time of hospital discharge in a geriatric population.
Am J Geriatr Pharmacother. 2011 Aug; 9(4):234-40.AJ

Abstract

BACKGROUND

It has been reported that 14.1% of geriatric patients experience ≥1 medication discrepancies after hospitalization.

OBJECTIVE

The goal of this study was to identify and characterize discharge medication list discrepancies among geriatric patients and to describe characteristics associated with discrepancies.

METHODS

An institutional review board-approved retrospective review was conducted of patients aged ≥65 years discharged from hospitalist and internal medicine services at a large tertiary care hospital from August 2008 to December 2009. A random cohort of 200 patients was selected and categorized by age, gender, attending medical service, and the absence or presence of a pharmacist on the service. Medication lists were obtained from physician discharge summaries, discharge orders, and nursing discharge lists.

RESULTS

A total of 1923 medication discrepancies were identified, consisting of 402 related to the absence or presence of a medication, 298 related to the dosage administered at one time, 223 related to the number of daily doses, and 1000 related to the route of administration. Physician discharge summaries contained the most medication discrepancies. There was no relationship between patient age and the number of medication discrepancies (r(2) = 0.006; P = 0.279), whereas there was a linear relationship between the number of medications and the number of discrepancies (r(2) = 0.249; P < 0.001). The internal medicine team with a pharmacist had a lower average number of discrepancies per patient compared with other medicine services that did not have a pharmacist present.

CONCLUSIONS

Medication discrepancies at the time of hospital discharge are a common occurrence for geriatric patients. Physician summaries might be the least reliable source of discharge medication lists. The number of discrepancies appears to not be associated with patient age, but rather with the number of medications at discharge. Discrepancies among medication lists are common, and the presence of a pharmacist may reduce the number that occur.

Authors+Show Affiliations

Saint Vincent Health Center, Erie, Pennsylvania, USA. dstitt@svhs.orgNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

21763215

Citation

Stitt, Danielle M., et al. "Medication Discrepancies Identified at Time of Hospital Discharge in a Geriatric Population." The American Journal of Geriatric Pharmacotherapy, vol. 9, no. 4, 2011, pp. 234-40.
Stitt DM, Elliott DP, Thompson SN. Medication discrepancies identified at time of hospital discharge in a geriatric population. Am J Geriatr Pharmacother. 2011;9(4):234-40.
Stitt, D. M., Elliott, D. P., & Thompson, S. N. (2011). Medication discrepancies identified at time of hospital discharge in a geriatric population. The American Journal of Geriatric Pharmacotherapy, 9(4), 234-40. https://doi.org/10.1016/j.amjopharm.2011.06.002
Stitt DM, Elliott DP, Thompson SN. Medication Discrepancies Identified at Time of Hospital Discharge in a Geriatric Population. Am J Geriatr Pharmacother. 2011;9(4):234-40. PubMed PMID: 21763215.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Medication discrepancies identified at time of hospital discharge in a geriatric population. AU - Stitt,Danielle M, AU - Elliott,David P, AU - Thompson,Stephanie N, Y1 - 2011/07/16/ PY - 2011/06/15/accepted PY - 2011/7/19/entrez PY - 2011/7/19/pubmed PY - 2012/5/26/medline SP - 234 EP - 40 JF - The American journal of geriatric pharmacotherapy JO - Am J Geriatr Pharmacother VL - 9 IS - 4 N2 - BACKGROUND: It has been reported that 14.1% of geriatric patients experience ≥1 medication discrepancies after hospitalization. OBJECTIVE: The goal of this study was to identify and characterize discharge medication list discrepancies among geriatric patients and to describe characteristics associated with discrepancies. METHODS: An institutional review board-approved retrospective review was conducted of patients aged ≥65 years discharged from hospitalist and internal medicine services at a large tertiary care hospital from August 2008 to December 2009. A random cohort of 200 patients was selected and categorized by age, gender, attending medical service, and the absence or presence of a pharmacist on the service. Medication lists were obtained from physician discharge summaries, discharge orders, and nursing discharge lists. RESULTS: A total of 1923 medication discrepancies were identified, consisting of 402 related to the absence or presence of a medication, 298 related to the dosage administered at one time, 223 related to the number of daily doses, and 1000 related to the route of administration. Physician discharge summaries contained the most medication discrepancies. There was no relationship between patient age and the number of medication discrepancies (r(2) = 0.006; P = 0.279), whereas there was a linear relationship between the number of medications and the number of discrepancies (r(2) = 0.249; P < 0.001). The internal medicine team with a pharmacist had a lower average number of discrepancies per patient compared with other medicine services that did not have a pharmacist present. CONCLUSIONS: Medication discrepancies at the time of hospital discharge are a common occurrence for geriatric patients. Physician summaries might be the least reliable source of discharge medication lists. The number of discrepancies appears to not be associated with patient age, but rather with the number of medications at discharge. Discrepancies among medication lists are common, and the presence of a pharmacist may reduce the number that occur. SN - 1876-7761 UR - https://www.unboundmedicine.com/medline/citation/21763215/Medication_discrepancies_identified_at_time_of_hospital_discharge_in_a_geriatric_population_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1543-5946(11)00115-2 DB - PRIME DP - Unbound Medicine ER -