High Prevalence of Medication Discrepancies Between Home Health Referrals and Centers for Medicare and Medicaid Services Home Health Certification and Plan of Care and Their Potential to Affect Safety of Vulnerable Elderly Adults.
To describe the prevalence of discrepancies between medication lists that referring providers and home healthcare (HH) nurses create.



The active medication list from the hospital at time of HH initiation was compared with the HH agency's plan of care medication list. An electronic algorithm was developed to compare the two lists for discrepancies.



Single large hospital and HH agency in the western United States.



Individuals referred for HH from the hospital in 2012 (N = 770, 96.3% male, median age 71).



Prevalence was calculated for discrepancies, including medications missing from one list or the other and differences in dose, frequency, or route for medications contained on both lists.



Participants had multiple medical problems (median 16 active problems) and were taking a median of 15 medications (range 1-93). Every participant had at least one discrepancy; 90.1% of HH lists were missing at least one medication that the referring provider had prescribed, 92.1% of HH lists contained medications not on the referring provider's list, 89.8% contained medication naming errors. 71.0% contained dosing discrepancies, and 76.3% contained frequency discrepancies.



Discrepancies between HH and referring provider lists are common. Future work is needed to address possible safety and care coordination implications of discrepancies in this highly complex population.
Geriatric Research Education and Clinical Center, James J. Peters Bronx Veterans Affairs Medical Center, Bronx, New York.|Hartford Institute for Geriatric Nursing, College of Nursing, New York University, New York, New York.
Abraham A
0000-0002-3405-7043
AA
Brody
Informatics Decision-Enhancement and Analytic Sciences, George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah.|Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah.
Bryan
B
Gibson
MITRE Corporation, Bedford, Massachusetts.|Brandeis University, Waltham, Massachusetts.
David
D
Tresner-Kirsch
Informatics Decision-Enhancement and Analytic Sciences, George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah.|Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah.
Heidi
H
Kramer
Geriatric Research Education and Clinical Center, George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah.|College of Social Work, University of Utah, Salt Lake City, Utah.
Iona
I
Thraen
MITRE Corporation, Bedford, Massachusetts.
Matthew E
ME
Coarr
Geriatric Research Education and Clinical Center, George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah.|Department of Geriatrics, University of Utah, Salt Lake City, Utah.
Randall
R
Rupper
D000368:Aged; D000465:Algorithms; D014487:Centers for Medicare and Medicaid Services, U.S. / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008484:Medicaid; D006278:Medicare; D008508:Medication Errors / Q000517:prevention & control / Q000706:statistics & numerical data; D059065:Medication Reconciliation / Q000379:methods / Q000592:standards; D054539:Medication Therapy Management / Q000458:organization & administration / Q000592:standards; D020380:Needs Assessment; D058996:Quality Improvement; D012017:Referral and Consultation / Q000592:standards / Q000706:statistics & numerical data; D017751:Safety Management / Q000379:methods / Q000592:standards; D000069341:Transitional Care / Q000458:organization & administration / Q000592:standards; D014481:United States
care coordination; home health; medication reconciliation; safety; transitional care
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