It’s not uncommon for nursing home patients to have discrepancies in their medication lists when they transition from hospital to the nursing home. In fact, published reports show that up to two-third of hospital patients being discharged to nursing homes will have at least one discrepancy in their medication list.
Resolving the mismatched prescribing information between hospital and nursing home and the potential risk it poses to patients places additional burdens on nursing home staff that shouldn’t be ignored, says Mark Patterson, Ph.D., M.P.H. associate professor of pharmacy practice and administration.
“It’s a problem that’s hard to solve because there are so many details,” Patterson said. “A patient’s medication list is an ever-changing source of information. Keeping medication lists current across care settings is difficult, but it needs to be resolved somehow.”
Patterson is the lead author of an article recently published in the Research in Social and Administrative Pharmacy Journal that outlined common challenges nursing homes face involving patient medication discrepancies. The article is the result of a collaborative study led by Patterson and Sandra Bollinger, Pharm.D., a UMKC School of Pharmacy graduate. It concluded that improving providers’ access to formularies and patient medical histories across the continuum of care and streamlining information sharing across transitions of care would decrease discrepancies while improving patient safety.
Patterson said the incompatible medication information sharing systems within and between health care facilities are a prevalent problem in the today’s health care system.
“It’s not necessarily only a problem of providers mistakenly reading information,” he said. “It’s the mismatched prescribing information gone unnoticed that leads to errors once the patient is admitted to the nursing home.”
Some of the challenges arise at the nursing home when care providers rely upon external providers for accurate prescribing information that is frequently delayed or outdated due to last-minute changes as a patient transitions from hospital to nursing home. Confusion also arises when hospital providers inadvertently prescribe medications at discharge that are covered on hospital insurance plans but not on outpatient insurance plans. The absence of standardized discharge or intake forms between facilities can also cause issues.
Patterson said the problem needs to be resolved using the current health information technology and training providers to properly input the correct information.
“In an ideal world, you want all facilities to conduct accurate and complete medication reconciliations. Ultimately, you want to prevent unintentional discrepancies detected during the medication reconciliation,” Patterson said. “That involves workflow, retooling how providers share information, how information technology works together. You’re ultimately trying to figure out a communication solution.”
Patterson said that is the next stage of his research.
“I’m eager to move forward,” he said. “Here are the issues we’ve figured out. That should be enough to get the ball rolling. Now, let’s start implementing some solutions.”