Background/purpose. The purpose of this study was to identify the patient and prescribing factors that predict medication discrepancy errors in older adults living in the community. In addition, this study explored the effect of medication discrepancy errors on nurse resource use.

Framework. A framework was developed to portray the factors typically associated with medication discrepancy errors and nurse resources needed to conduct medication reconciliation. The patient characteristics of age, living arrangements, physical function, cognition, depression, and financial barriers were identified as factors that potentially contribute to medication discrepancy errors. In addition, the prescribing factors, including total number of prescribers and medication complexity, are also associated with an increase in medication discrepancy errors.

Design/methods. A descriptive cross sectional design using secondary data analysis from the Home Care Medication Management for the Frail Elderly study (5RO1-NR008911-03) was utilized. Multiple regression analyses were used to assess which patient or prescriber variables best predict medication discrepancy errors and nurse resource use.

Findings. Sixty-eight percent of subjects were found to have at least one medication discrepancy error (68.9%, n = 273) at enrollment into the primary study. The mean number of medication changes during the nurse-driven medication reconciliation process was 2.54 (SD = 3.489). The mean number of nurse encounters needed to reconcile medications was 2.34 (SD = 1.371). Medication complexity (p =.002) was the most significant contributor to medication discrepancy errors. The number of medication discrepancy errors (p<.001) and medication complexity (p =.032) were the most significant in predicting nurse resource use.

Conclusions. The study results have revealed a staggering number of medication discrepancy errors in older adults living in the community post home health care. Medication complexity contributes to the number of medication discrepancy errors and subsequent nurse resource use. This study has added new knowledge about the role of the nurse in medication reconciliation process.

Clinical relevance. Unlike medication errors in the acute care setting, medication management and medication reconciliation process in the community has not been comprehensively studied. Knowledge of patient and prescribing factors that are associated with medication discrepancy errors will provide useful information to design future nursing interventions.