Advertisement

Journal of General Internal Medicine

, Volume 24, Issue 5, pp 630–635 | Cite as

Medication Discrepancies upon Hospital to Skilled Nursing Facility Transitions

  • Jennifer Tjia
  • Alice Bonner
  • Becky A. Briesacher
  • Sarah McGee
  • Eileen Terrill
  • Kathleen Miller
Original Article

Abstract

BACKGROUND

Failure to reconcile medications across transitions in care is an important source of harm to patients. Little is known about medication discrepancies upon admission to skilled nursing facilities (SNFs).

OBJECTIVE

To describe the prevalence of, type of medications involved in, and sources of medication discrepancies upon admission to the SNF setting.

DESIGN

Cross-sectional study.

PARTICIPANTS

Patients admitted to SNF for subacute care.

MEASUREMENTS

Number of medication discrepancies, defined as unexplained differences among documented medication regimens, including the hospital discharge summary, patient care referral form and SNF admission orders.

RESULTS

Of 2,319 medications reviewed on admission, 495 (21.3%) had a medication discrepancy. At least one medication discrepancy was identified in 142 of 199 (71.4%) SNF admissions. The discharge summary and the patient care referral form did not match in 104 of 199 (52.3%) SNF admissions. Disagreement between the discharge summary and the patient care referral form accounted for 62.0% (n = 307) of all medication discrepancies. Cardiovascular agents, opioid analgesics, neuropsychiatric agents, hypoglycemics, antibiotics, and anticoagulants accounted for over 50% of all discrepant medications.

CONCLUSIONS

Medication discrepancies occurred in almost three out of four SNF admissions and accounted for one in five medications prescribed on admission. The discharge summary and the patient care referral forms from the discharging institution are often in disagreement. Our study findings underscore the importance of current efforts to improve the quality of inter-institutional communication.

KEY WORDS

medication discrepancies skilled nursing facilities medication reconciliation discharge summary transitions of care 

Notes

Acknowledgements

We gratefully acknowledge Jerry Gurwitz, MD, for his support of this project, the work of the research team advance practice nurses Francisca Adams, Suzanne Sullivan, and Anne Crowell, research assistant Diane Quinn, and Jennifer Donovan, PharmD, Abir Kanaan, Pharm D, and Jane L. Givens, MD, MSCE, for their assistance with this manuscript.

Funding/support

Dr. Tjia was supported by a Mentored Clinical Scientist Career Development Award from the National Institute on Aging (K08 AG021527). This study was supported by a grant from the Rosalie Wolf Interdisciplinary Geriatric Health Care Research Center at the University of Massachusetts Medical School and the University of Massachusetts Boston funded by the John A. Hartford Foundation and the RAND Corporation.

Financial Disclosures

Dr. Briesacher has received unrestricted research grants from and served as a consultant for Novartis Pharmaceutical Corporation within the past 3 years.

References

  1. 1.
    Coleman EA, Smith JD, Raha D, et al. Posthospital medication discrepancies: prevalence and contributing factors. Arch Intern Med. 2005;165:1842–7.PubMedCrossRefGoogle Scholar
  2. 2.
    The Joint Commission. 2008 National Patient Safety Goals - Long-term Care Program [On-line] http://www.jointcommission.org/PatientSafety/NationalPatientSafetyGoals/ 08_ltc_npsgs.htm. Accessed February 13, 2009.
  3. 3.
    Santell JP. Reconciliation failures lead to medication errors. J Qual Patient Saf. 2006;32:225–9.Google Scholar
  4. 4.
    Tam VC, Knowles SR, Cornish PL, et al. Frequency, type and clinical importance of medication history errors at admission to hospital: a systematic review. CMAJ. 2005;173:510–5.PubMedGoogle Scholar
  5. 5.
    Cornish PL, Knowles SR, Marchesano R, et al. Unintended medication discrepancies at the time of hospital admission. Arch Intern Med. 2005;165:424–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Schnipper JL, Kirwin JL, Cotugno MC, et al. Role of pharmacist counseling in preventing adverse drug events after hospitalization. Arch Intern Med. 2006;166:565–71.PubMedCrossRefGoogle Scholar
  7. 7.
    Wong JD, Bajcar JM, Wong GG, et al. Medication reconciliation at hospital discharge: evaluating discrepancies. Ann Pharmacother. 2008;42:1373–9.PubMedGoogle Scholar
  8. 8.
    Vira T, Colquhoun M, Etchells E. Reconcilable differences: correcting medication errors at hospital admission and discharge. Qual Saf Health Care. 2006;15:122–6.PubMedCrossRefGoogle Scholar
  9. 9.
    Wong JD, Bajcar JM, Wong GG, et al. Medication reconciliation at hospital discharge: evaluating discrepancies. Ann Pharmacother. 2008;42:1373–9.PubMedGoogle Scholar
  10. 10.
    Liu K, Garrett B, Wissoker D, et al. Options for improving medicare payment for skilled nursing facilities: Centers for Medicare and Medicaid Services (CMS); 2007. Available at: http://www.urban.org/url.cfm?ID=411526. Accessed February 13, 2009.
  11. 11.
    Yip JY, Wilber KH, Myrtle RC. The impact of the 1997 Balanced Budget Amendment's prospective payment system on patient case mix and rehabilitation utilization in skilled nursing. Gerontologist. 2002;42:653–60.PubMedGoogle Scholar
  12. 12.
    Michaud Y, ed. A systems approach to quality improvement in long-term care: safe medication practices workbook. Massachusetts Coalition to Prevent Medical Errors. 2007. Available at: http://www.masspro.org/NH/docs/tools/SafeMedPrac06_8-07Upd.pdf. Accessed February 13, 2009.
  13. 13.
    Wilson S, Ruscoe W, Chapman M, Miller R. General practitioner-hospital communications: a review of discharge summaries. J Qual Clin Pract. 2001;21:104–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Kripalani S, LeFevre F, Phillips CO, Williams MV, Basaviah P, Baker DW. Deficits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care. JAMA. 2007;297(8):831–41.PubMedCrossRefGoogle Scholar
  15. 15.
    Lisby M, Nielsen LP, Mainz J. Errors in the medication process: frequency, type, and potential clinical consequences. Int J Qual Health Care. 2005; 17: 15–22.PubMedCrossRefGoogle Scholar
  16. 16.
    Nickerson A, MacKinnon NJ, Roberts N, Saulnier L. Drug-therapy problems, inconsistencies and omissions identified during a medication reconciliation and seamless care service. Healthc Q. 2005;8:65–72.PubMedGoogle Scholar
  17. 17.
    Varkey P, Cunningham J, O'Meara J, Bonacci R, Desai N, Sheeler R. Multidisciplinary approach to inpatient medication reconciliation in an academic setting. Am J Health Syst Pharm. 2007;64:850–4.PubMedCrossRefGoogle Scholar
  18. 18.
    Soumerai SB, Avorn J, Ross-Degnan D, et al. Payment restriction for prescription drugs under Medicaid. N Engl J Med. 1987;317:1072–7.CrossRefGoogle Scholar
  19. 19.
    Soumerai SB, Ross-Degnan D, Avorn J, et al. Effects of Medicaid drug-payment limits on admission to hospitals and nursing homes. N Engl J Med. 1991;325:1072–7.PubMedGoogle Scholar
  20. 20.
    Forster AJ, Murff HJ, Peterson JF, Gandhi TK, Bates DW. The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med. 2003;138:161–7.PubMedGoogle Scholar
  21. 21.
    Boockvar K, Fishman E, Kyriacou CK, Monias A, Gavi S, Cortes T. Adverse events due to discontinuations in drug use and dose changes in patients transferred between acute and long-term care facilities. Arch Intern Med. 2004;164:545–50.PubMedCrossRefGoogle Scholar
  22. 22.
    Forster AJ, Clark HD, Menard A, et al. Adverse events among medical patients after discharge from hospital. CMAJ. 2004;170:345–9.PubMedGoogle Scholar
  23. 23.
    Halasyamani L, Kripalani S, Coleman E, et al. Transition of care for hospitalized elderly patients–development of a discharge checklist for hospitalists. J Hosp Med. 2006;1(6):354–60.PubMedCrossRefGoogle Scholar
  24. 24.
    Jack BW, Chetty VK, Anthony D, et al. A reengineered hospital discharge program to decrease rehospitalization. Ann Intern Med. 2009;150:178–87.PubMedGoogle Scholar
  25. 25.
    Medicare Payment Advisory Commission. Report to the Congress: Promoting greater efficiency in Medicare. 2007. Available at: http://www.medpac.gov/documents/ Jun07_EntireReport.pdf. Accessed February 13, 2009.

Copyright information

© Society of General Internal Medicine 2009

Authors and Affiliations

  • Jennifer Tjia
    • 1
  • Alice Bonner
    • 2
  • Becky A. Briesacher
    • 1
  • Sarah McGee
    • 1
  • Eileen Terrill
    • 2
  • Kathleen Miller
    • 2
  1. 1.Division of Geriatric MedicineUniversity of Massachusetts Medical SchoolWorcesterUSA
  2. 2.University of Massachusetts Worcester, Graduate School of NursingWorcesterUSA

Personalised recommendations