Journal of General Internal Medicine

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

Medication Discrepancies upon Hospital to Skilled Nursing Facility Transitions

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



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).


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


Cross-sectional study.


Patients admitted to SNF for subacute care.


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.


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.


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.


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



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.


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.


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Copyright information

© Society of General Internal Medicine 2009

Authors and Affiliations

  • Jennifer Tjia
    • 1
    Email author
  • 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

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