Original Study| Volume 22, ISSUE 5, P1003-1008, May 2021

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Getting to Complete and Accurate Medication Lists During the Transition to Home Health Care



      Characterize the work that home health care (HHC) admission nurses complete as part of the medication reconciliation tasks, explore the impact of shared electronic medication data (interoperability) from the referral source on medication reconciliation, and highlight opportunities to enhance medication reconciliation with respect to transition in care to HHC agencies.


      Observational field study.

      Settings and Participants

      Three diverse Pennsylvania HHC agencies; each used different electronic health record systems with different interoperability characteristics. Six nurses per site admitted 2 patients each (36 patients total).


      Researchers observed the admission process in the patient home and at the HHC agency. The nurses’ tasks related to medication reconciliation were characterized by (1) number and change types (ie, medications dropped or added; changes to dose, frequency/administration time, or tablet types) made to the referrer medication list during and after the home visit, and (2) reasons that the nurse called the health provider (doctor, pharmacy) to resolve medication-related issues. Differences between interoperable and non-interoperable observations were explored.


      Polypharmacy (on average, study patients were taking more than 12 medications) and high-risk medications (on average, more than 8 per patient) were pervasive. For 91% of patients, the number of medications decreased between pre- and post-reconciliation medication lists; 41% of the medications required changes. Nurses using interoperable systems needed to make fewer changes than nurses using non-interoperable systems. In two-thirds of observations, the nurse called a provider.

      Conclusions and Implications

      Changes to the referrer medication list and calls to providers highlighted the nurses’ effort to complete the medication reconciliation. Interoperability appeared to reduce the number of changes required, but did not eliminate changes or calls to providers. We highlight opportunities to enhance medication reconciliation with respect to transition in care to HHC agencies.


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        • The Joint Commission on the Accreditation of Healthcare Organizations
        National patient safety goals effective January 2017: Home care accreditation program. 2017.
        (Available at:)
        • Forster A.J.
        • Murff H.J.
        • Peterson J.F.
        • et al.
        Adverse drug events occurring following hospital discharge.
        J Gen Intern Med. 2005; 20: 317-323
        • Forster A.J.
        • Murff H.J.
        • Peterson J.F.
        • et al.
        The incidence and severity of adverse events affecting patients after discharge from the hospital.
        Ann Intern Med. 2003; 138: 161-167
        • Agency for Healthcare Research and Quality
        Medication reconciliation. Patient Safety Primer 2019.
        (Available at:)
        Date accessed: December 12, 2019
        • Brody A.
        • Gibson B.
        • Tresner-Kirsch D.
        • et al.
        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.
        J Am Geriatr Soc. 2016; 64: 5
        • Hale J.
        • Neal E.B.
        • Myers A.
        • et al.
        Medication discrepancies and associated risk factors identified in home health patients.
        Home Healthc Now. 2015; 33: 493-499
        • Corbett C.F.
        • Setter S.M.
        • Daratha K.B.
        • et al.
        Nurse identified hospital to home medication discrepancies: implications for improving transitional care.
        Geriatr Nurs. 2010; 31: 188-196
        • Hu S.H.
        • Capezuti E.
        • Foust J.B.
        • et al.
        Medication discrepancy and potentially inappropriate medication in older Chinese-American home-care patients after hospital discharge.
        Am J Geriatr Pharmacother. 2012; 10: 284-295
        • Sarzynski E.
        • Ensberg M.
        • Parkinson A.
        • et al.
        Health information exchange of medication lists: hospital discharge to home healthcare.
        Home Healthc Now. 2019; 37: 33-35
        • Agency for Healthcare Research and Quality
        Six domains of health care quality 2018.
        (Available at:)
        • Cipriano P.F.
        • Bowles K.
        • Dailey M.
        • et al.
        The importance of health information technology in care coordination and transitional care.
        Nurs Outlook. 2013; 61: 475-489
        • Popejoy L.
        • Galambos C.
        • Vogelsmeier A.
        Hospital to nursing home transition challenges: Perceptions of nursing home staff.
        J Nurs Care Qual. 2014; 29: 103-109
        • Jones C.D.
        • Cumbler E.
        • Honigman B.
        • et al.
        Hospital to post-acute care facility transfers: Identifying targets for information exchange quality improvement.
        J Am Med Dir Assoc. 2017; 18: 70-73
        • Samal L.
        • Dykes P.
        • Greenberg J.O.
        • et al.
        Care coordination gaps due to lack of interoperability in the United States: A qualitative study and literature review.
        BMC Health Serv Res. 2016; 16: 1-8
      1. Interoperability 2019.
        (Available at:)
        • Jones C.D.
        • Jones J.
        • Bowles K.H.
        • et al.
        Quality of hospital communication and patient preparation for home health care: Results from a statewide survey of home health care nurses and staff.
        J Am Med Dir Assoc. 2019; 20: 487-491
        • Saedder E.A.
        • Brock B.
        • Nielsen L.P.
        • et al.
        Identifying high-risk medication: a systematic literature review.
        Eur J Clin Pharmacol. 2014; 70: 637-645
        • Charlesworth C.J.
        • Smit E.
        • Lee D.S.
        • et al.
        Polypharmacy among adults aged 65 years and older in the United States: 1988–2010.
        J Gerontol A Biol Sci Med Sci. 2015; 70: 989-995
        • Qato D.M.
        • Wilder J.
        • Schumm L.P.
        • et al.
        Changes in prescription and over-the-counter medication and dietary supplement use among older adults in the United States, 2005 vs 2011.
        JAMA Intern Med. 2016; 176: 473-482
        • Abolhassani N.
        • Castioni J.
        • Marques-Vidal P.
        • et al.
        Determinants of change in polypharmacy status in Switzerland: The population-based CoLaus study.
        Eur J Clin Pharmacol. 2017; 73: 1187-1194
        • National Committee for Quality Assurance
        HEDIS Measures and Technical Resources.
        (Available at:)
        Date accessed: December 12, 2019
        • National Quality Forum
        CARE-1 (NQF 0097): Medication Reconciliation Post Discharge.
        (Available at:)
        • Foust J.B.
        • Naylor M.D.
        • Bixby M.B.
        • Ratcliffe S.J.
        Medication problems occurring at hospital discharge among older adults with heart failure.
        Res Gerontol Nurs. 2012; 5: 9