Types of Discrepancies in Medications & Instructions At Hospital Discharge

Error in medication:

(1) necessary drug not restarted

(2) wrong dose

(3) wrong schedule

(4) drug interaction not detected

(5) introduction of an unnecessary drug

where:

• Starting a wrong drug is a combination of errors 1 and 5.

Failure to notify the patient:

(1) of a change in dose or schedule

(2) of a new drug and how to take it

(3) to discontinue a previously taken drug

The number of high risk medications involved by the discrepancies determines the significance of these discrepancies.

Other failures not mentioned:

(1) failure to communicate promptly with the primary care provider

(2) failure to adjust dosages of drugs affected by changes to the drug regimen