Post-Hospital Medication Discrepancies: The Safe Care Gap

Tuesday, July 12, 2011: 10:50 AM

Linda Costa, PhD, RN
Nursing Administration, The Johns Hopkins Hospital, Johns Hopkins University School of Nursing, Baltimore, MD
Stephanie S. Poe, DNP, RN
Department of Nursing Administration, The Johns Hopkins Hospital, Baltimore, MD
Mei Ching Lee, MS, BSN
Center for Nursing Research, The Johns University School of Nursing, Baltimore, MD

Learning Objective 1: Quantify the value of telephone follow-up compared to a home visit in detecting medication discrepancies after hospital discharge.

Learning Objective 2: Discuss the use of open dialogue in the home rather than structured interview of chronically-ill patients to improve self-management and resolve medication discrepancies

Purpose: Transition from acute hospitalization to home is a time when the care needs of inpatients are transferred from an expert health care team to the individual and family.  Little is known about the time between hospital discharge and the primary care visit. This research study tested if a hospital-based nurse coaching intervention with patients discharged on complex medication regimens could detect and resolve post-discharge medication discrepancies.

 Methods:  This non-experimental pilot study enrolled adult medicine patients on four or more prescription medications. The intervention included:  1) Hospital interview and medication reconciliation ; 2) 48-hour post-discharge telephone call with structured interview and medication reconciliation; (3) Home visit within 14-days of discharge to observe medication use in the home and disease symptoms; and Telephone follow-up at 30 days to assess discrepancy resolution. A pharmacist was available for consultation.

 Results: Of the 72 patients approached, 32 entered the study: 100 percent were emergency admissions, 87 percent were female; 94 percent were African-American; and 50 percent were under 65 years old. An average of 10.6 +4.1 medications were prescribed at discharge   Medication discrepancies were found in 67 percent of participants either by telephone interview or home visit.  The nurses identified 36 medication discrepancies during home visits. In 10 of 16 (62.5%) patients, the nurses found medication discrepancies in the home that were not detected by telephone interview. Medication omission was the most common discrepancy. Understanding daily routines of patients and families assisted nurses direct the coaching intervention. Open dialogue was used to focus on what was working well in managing their health.  This approach allowed assessment of potential areas for improvement.

Conclusion: Dialogue in the home rather than telephone interview of chronically-ill patients yielded a cooperative environment allowing patients and families to ask openly for information needed to improve self-management and resolve medication discrepancies.