High Prevalence of Medication Discrepancies Between Home Health Referrals and CMS 485 Plans of Care and its Potential to Affect Patient Safety in Vulnerable Elders

Abstract

Background:

Many homebound older adults require Home Healthcare (HH). Nurses in HH go to a patient’s home, conduct an assessment and may request changes to the plan of care (including medications), which is returned to the referring provider for approval. To date, little research has examined prevalence of discrepancies in medication lists between HH referrals and the HH plan of care.

Objective:

The study sought to describe prevalence of discrepancies between medication lists created by referring providers and HH nurses.

Setting:

Single large hospital and HH agency in the Western United States

Participants:

770 patients referred for HH from the hospital in 2012.

Design:

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

Measurements:

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.

Results:

Patients were primarily male (96.3%) older (median age 71) and had multiple medical problems (median of 16 active problems). Individuals took a median of 15 medications (range 1–93). Every patient had at least one discrepancy: 90.1% of HH lists were missing at least one medication prescribed by the referring provider, 92.1% of HH lists contained medications not on the referring provider’s list, 89.8% contained medications having naming errors. 71.0% contained dosing discrepancies, 76.3% contained frequency discrepancies.

Conclusions:

Discrepancies between HH and referring provider lists are common. Future work is needed to address possible patient safety and care coordination implications of discrepancies in this highly complex population.