Identifying Potential Medication Discrepancies During Medication Reconciliation in the Post-Acute Long-Term Care Setting.

Medication reconciliation has been an area with increased focus among transitions of care due to associations with error rates and risk of patient harm. Chart reviews were performed to evaluate the discrepancies between the initial physician order sheet (POS), hospital discharge summary, electronic health record (EHR), health information exchange (HIE), and the patient interview/home medication list. The objectives were to determine which medication information source provided the least number of discrepancies and describe the different types of discrepancies among sources. Of all orders, 30% contained a discrepancy. The average number of discrepancies per medication source per patient included: 5.6 for the hospital discharge summary, 7.6 for the EHR, and 9.6 for the home medication list/interview. The most frequent types of discrepancies included: omission of medication orders between lists (42.7%), additional medications not included on the initial POS (24.6%), and discrepancies in frequency (11.8%). The hospital discharge summary proved to be the medication source that provided the least number of discrepancies, compared to the initial POS. [Journal of Gerontological Nursing, 45(7), 5-10.].