- Research in Gerontological Nursing
- January 2012 - Volume 5 · Issue 1: 25-33
Medication reconciliation problems are common among older adults at hospital discharge and lead to adverse events. The purpose of this study was to examine the rates and types of medication reconciliation problems among older adults hospitalized for acute episodes of heart failure who were discharged home. This secondary analysis of data generated from a transitional care intervention included 198 hospital discharge medical records, representing 162 patients. A retrospective chart review comparing medication lists between hospital discharge summaries and patient discharge instructions was completed to identify medication reconciliation problems. Most hospital discharges (71.2%) had at least one type of reconciliation problem and frequently involved a high-risk medication (76.6%). Discrepancies were the most common problem (58.9%), followed by incomplete discharge summaries (52.5%) and partial patient discharge instructions (48.9%). More attention needs to be given to the quality of discharge instructions, and the problem of vague phrases (e.g., “take as directed”) can be addressed by adding it to “do not use” lists to promote safer transitions in care.
Dr. Foust is Assistant Professor, University of Massachusetts Boston, Department of Nursing, Boston, Massachusetts; Dr. Naylor is Marian S. Ware Professor in Gerontology and Director, NewCourtland Center for Transitions and Health, Mr. Bixby is Advanced Practice Nurse, University of Pennsylvania, School of Nursing, and Dr. Ratcliffe is Associate Professor of Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania. Dr. Foust completed portions of this work while at the Center for Home Care Policy and Research, Visiting Nurse Service of New York, and the University of New Hampshire, Department of Nursing.
The authors disclose that they have no significant financial interests in any product or class of products discussed directly or indirectly in this activity. The authors gratefully acknowledge funding from the John A. Hartford Foundation (JAHF) Building Academic Geriatric Nursing Capacity Program. Dr. Foust is a 2003–2005 JAHF Claire M. Fagin Postdoctoral Fellow, Hartford Center of Geriatric Nursing Excellence, University of Pennsylvania, School of Nursing. The authors thank J. Sanford Schwartz, MD, Principal Investigator, National Institutes of Health grant RO1-NR07616 for his support. Portions of this work have been presented at annual meetings of the Gerontological Society of America in November 2003, 2005, and 2008.
Address correspondence to Janice B. Foust, PhD, RN, Assistant Professor, University of Massachusetts Boston, 100 Morrissey Boulevard, Boston, MA 02125; e-mail: email@example.com.
Received: May 18, 2011
Accepted: October 11, 2011
Posted Online: December 29, 2011