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An innovative method for discharge medication reconciliation was developed by nurses to ensure safe transition of care and improved patient outcomes. The discharge time-out process has empowered nurses to take a more active role in discharging their patients, and has fostered a more collaborative relationship between nurses and physicians.
Hospital discharge can be a stressful time for patients transitioning from acute care into the community. The transition from hospital to home is a complex and potentially dangerous process for patients, and a challenge for health care providers. Although many hospital leaders eagerly try to set standards for discharge practices, others struggle with the need for increased services with fewer resources. Successful transition to home is multifaceted and depends partially on accurate, complete medication reconciliation for patient safety across the continuum of care (Alper, O'Malley, Greenwald, Aronson, & Park, 2014; Corbett, Setter, Daratha, Neumiller, & Wood, 2010; Foust, Naylor, Bixby, & Ratcliffe, 2012; Greenwald et al., 2010).
A retrospective study by Foust and co-authors (2012) found 71.2% (n=141) of hospital discharges had at least one type of medication reconciliation problem; medication discrepancy was the most common error (58.9%, n=83) at time of discharge. Of the 375 discharged patients in a study by Coleman, Smith, Raha, and Min (2005), 53 (14.1%) experienced one or more medication discrepancies, with 49.2% (n=61) of those categorized as system related. Of patients who experienced medication discrepancies, 14.3% (n=7) were rehospitalized within 30 days compared with 6.1% (n=3) who did not experience discrepancies. Among post-hospital adverse events, medications were the most common problem (66%-72%), and nearly all post-hospital adverse drug events (ADEs) involved new medication or dosage change at time of discharge (Forster, Murff, Peterson, Gandhi, & Bates, 2005). Data on ADEs after discharge are limited; however, in one study, ADE occurrence was reported in 35% (n=70) of adults taking more than five medications daily; 84% (n=58) required medical attention and 11% (n=7) required hospitalization (Bayoumi, Howard, Holbrook, & Schabort, 2009).
The Joint Commission has set National Patient Safety Goals (NPSGs) to guide hospitals in using uniformed best practices. Medication reconciliation was introduced in 2005 as NSPG 8. It was revised and reintroduced in 2011 in an effort to recognize and resolve medication discrepancies and minimize the risk of adverse events...