Medication discrepancies across care transitions and the role of pharmacy technicians: A retrospective chart review

Abstract

Background

After hospitalization, older adults are increasingly discharged to postacute care facilities such as skilled nursing facilities (SNFs). Medication reconciliation and obtaining the best possible medication history (BPMH) are key components of medication management for care transitions and essential for preventing medication errors and adverse drug events.

Objective

This study aimed to assess medication discrepancies across care transitions after a Certified Pharmacy Technician (CPhT) obtains the BPMH on hospital admission.

Methods

Single-center, retrospective chart review and included adults ≥ 18 years admitted to the medicine service and discharged to a SNF between November 2016 and June 2017. Medication lists were evaluated for discrepancies across 3 transitions: hospital admission to hospital discharge (Time I), hospital discharge to SNF admission (Time II), and SNF admission to SNF discharge (Time III). Discrepancies were categorized by medication class, type of discrepancy, and whether it was potentially intentional or unintentional.

Results

In 127 patients, the average age was 83.3 (SD 9.16), 61% (n = 77) were female, and 67% (n = 85) were white. Median hospital length of stay (LOS) was 6 days (interquartile range [IQR] 4-10) and SNF LOS 21 days (IQR 15-30). Across 381 transitions, 6322 medications were reviewed, and 2602 discrepancies identified. The total number of medication discrepancies was 1034 (Time I), 687 (Time II), and 881 (Time III), respectively. All patients had at least one medication discrepancy. The average number of potentially unintentional discrepancies per patient at each transition was 0.14, 0.2, and 0.16, respectively. The most common discrepancy type was omissions (39%), and the highest number of discrepancies in the potentially intentional and unintentional discrepancy groups was gastrointestinal (21%) and cardiovascular medications (24%), respectively.

Conclusion

Medication discrepancies are common across all care transitions. Future studies are needed to evaluate the role of CPhT in obtaining the BPMH on hospital admission for reducing medication discrepancies across the continuum of care.