Medication Reconciliation: Identifying Medication Discrepancies in Acutely Ill Hospitalized Older Adults

Medication discrepancies in older patients admitted to non-geriatric wards: An exploratory study

“…These findings suggest that medication history-taking was a low priority for clinicians attending to patients admitted for a planned procedure, who were the majority of participants. The frequency of discrepancies and the most common types observed in this study of older people admitted to non-geriatric wards are corroborated by previous studies [1][2][3][7][8][9][10][11]. The rate of discrepancies of potential moderate clinical impact observed in this study (31% of all discrepancies) is lower than in general internal medicine wards (39%) and in geriatric wards (57-72%) [1,3,7].…”

“…Moreover, many studies have reported the point prevalence of discrepancies, frequent types and pharmacological classes concerned. However, previous research has not explored the potential clinical impact of discrepancies by pharmacological (sub-)class in order to understand where greatest attention should be paid in clinical practice [1][2][3][6][7][8][9][10][11]. Therefore, this study aims to assess home medication discrepancies categorised by type and by pharmacological (sub-)class, to determine the relationship between discrepancies and patients' clinical profile, and to investigate the possible clinical impact of discrepancies occurring in a non-geriatric setting.…”

“…Uncorrected discrepancies may continue throughout hospitalisation and after discharge, impeding appropriate pharmacotherapy [1,2]. Recent studies show that 40-92% of older patients admitted to geriatric wards have discrepancies in their home medication lists [1][2][3]. Medicines reconciliation can reduce discrepancies and is defined as ''the process of identifying the most accurate list of a patient's current medicines -including the name, dosage, frequency and route -and comparing them to the current list in use, recognizing discrepancies, and documenting any changes, thus resulting in a complete list of medications, accurately communicated'' [4].…”

Back to Basics

“…Medication discrepancies are costly in terms of morbidity, increased duration of stay, and costs. 44 Accurate inputs and outputs will be necessary to ensure adequate hydration and resolution of her acute renal failure. Her renal system is already compromised owing Back to Basics to her age and current physiologic condition, but electrolyte imbalance is a real possibility, and with her history of heart failure, you must keep on top of all of these factors to prevent lethal arrhythmias.…”

“Sundowning” as a biological phenomenon: current understandings and future directions: an update

“…Unfortunately, the side effects associated with these medications have been a rate-limiting factor on the utility of these medications. Medication discrepancies have been identified as the leading cause of reversible behavioral problems noted in the elderly population [75]. Almost 66 % of all hospital admissions have been related to adverse drug reactions [22].…”