Identifying medication order discrepancies during medication reconciliation: perceptions of nursing home leaders and staff

Abstract

The purpose of this qualitative study was to explore nursing home leader and staff nurse perceptions about the process of medication reconciliation, with a specific focus on identifying medication order discrepancies. Medication order discrepancies and harmful discrepancy-related adverse drug events can occur when residents make the transition to nursing homes, yet little is known about how discrepancies are identified in this setting. Interviews of 18 leaders and focus groups of 13 registered nurses and 28 licensed practical nurses from eight mid-western United States nursing homes were conducted. Three themes emerged from the data: (1) nurses believe nursing home physicians rely on them to know, (2) active vs. passive information-seeking, and (3) nurses making sense of medication orders to identify discrepancies. This study provides evidence about the role of nursing home nurses in medication reconciliation and how nurses engage in cognitive processes, such as 'sensemaking', when identifying discrepancies. Nursing leaders and managers must acknowledge that medication reconciliation is a complex cognitive process that requires the right nurse be assigned to the role, taking into account education and experience. Additionally, systems to support collaboration between physicians, nurses and pharmacists should be in place to ensure that potentially harmful discrepancies are identified and resolved.