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

K. Perehudoff, M. Azermai, A. Somers, R. Vander Stichele, M. Petrovic

Research output: Contribution to journalArticleAcademicpeer-review

9 Citations (Scopus)


Background: Discrepancies between actual home medication and those recorded at admission are a recognised safety concern for older inpatients. Few studies have investigated discrepancies on nongeriatric wards where pharmaceutical care may be less tailored to the needs of older patients. Purpose: To assess home medication discrepancies categorised by type and clinical impact and, to explore the relationship with patients’ clinical profiles. Materials & methods: This was an observational study in non-geriatric wards in a single hospital without electronic communication with community pharmacies. Subjects were inpatients 70 years. Home medication assessment occurred through standard care (physician/nurse) and structured medication reconciliation (hospital pharmacist). Discrepancies, defined as any difference in the medications lists resulting from the two methods, their relationship with patient profiles and their potential clinical impact were assessed. Results: Patients’ (n = 78) mean age was 79 years and 63% were females; 60% of patients (n = 47) were affected by 92 discrepancies, mean 1.96/affected patient (range 1–6). Predominant discrepancies were doses or medications (errors of omission or commission). Discrepancies of moderate clinical impact (31% of affected patients) concerned the majority of respiratory and cardiovascular drugs. The proportion of discrepancies was higher in patients with polypharmacy (P = 0.001) and with an indication of lower functional status (P = 0.032). Discussion & conclusion: Medication discrepancies occurring at admission to non-geriatric wards are common in older inpatients and their potentially moderate clinical impact reinforces their importance to patient safety.
Original languageEnglish
Pages (from-to)41-45
Number of pages5
JournalEuropean Geriatric Medicine
Issue number1
Publication statusPublished - Feb-2015
Externally publishedYes


  • medication discrepancy
  • older patients
  • clinical pharmacist


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