Assignment Prompt & Instructions
**files (2)**
– ## KTAAssignmentinstructions.docx
– ## ReducingMedicationErrorsthroughMedicationReconciliationatAdmissionandDischarge.docx
**## KTAAssignmentinstructions.docx**
1. You are going to construct an APA formatted paper for the assignment.
2. Provide an APA formatted title page.
3. Develop an introduction section that includes the professional nurses’ role in using evidence from the literature to address a practice problem.
4. Provide a review of the practice problem and supporting evidence of its existence and significance using the
**original article only** from the Unit 4 literature list (include any suggested edits from the faculty).
5. Search for evidence-based interventions from scholarly literature to address this practice problem and choose ONE from this search that is the best fit for implementation if the problem existed in YOUR CLINICAL PRACTICE
6. Write a Literature Review for your selected intervention supported with three (3) articles.
7. Explain why this is the best evidence-based intervention for your clinical practice setting.
1.
1.
**NOTE**: the three (3) additional articles for the literature review cannot be articles that are referenced in the primary article you selected from the list in Unit 4.
2. Ideally the 3 additional articles discussing this single intervention will have a publication date within the last 5 to 10 years.
3.
Do not do a summary of each intervention individually. Refer to the video on Your First Literature Review for organization of this section.
8. Develop a conclusion section for the paper that summarizes the content and your thoughts about the significance of the using evidence from the literature to address practice problems.
9. Provide an APA formatted reference page and include citations for each source in the body of the assignment where appropriate.
10. The suggested length for this submission, excluding title and reference pages, is no less than 3 pages.
**The assignment requirements include that you upload a file of the full-text article for each listed reference.**
Breuker, C., Macioce, V., Mura, T., Castet-Nicolas, A., Audurier, Y., Boegner, C., &
Sultan, A. (2021). Medication errors at hospital admission and discharge:
Risk factors and impact of medication reconciliation process to improve
healthcare.
Journal of Patient Safety,
17(7), e645-e652.
https://doi.org/10.1097/PTS.0000000000000420
**## ReducingMedicationErrorsthroughMedicationReconciliationatAdmissionandDischarge.docx**
1
**Reducing Medication Errors through Medication Reconciliation at Admission and Discharge**
Student’s Name
Institutional Affiliation
Course
Instructor
Date
**Reducing Medication Errors through Medication Reconciliation at Admission and Discharge**
Nurses are at the center of practice problem identification, as they are the points where patient needs, system processes, and clinical outcomes meet. Nurses often identify persistent gaps in care provision through direct patient evaluation, medication administration, discharge planning, incident report review, and involvement in quality improvement programs. Medication errors during care transitions are one of the most prevalent and impactful problems in practice that nurses can observe. Admission and discharge times are particularly susceptible as far as medication lists can be either incomplete or obsolete, or the communication can be poor across settings. Such malfunctions subject patients to avoidable injuries and raise the cost of healthcare consumption. This paper examines the practice problem of unintended medication discrepancies and errors at hospital admission and discharge, as identified in Breuker et al. (2021). It discusses the existence and significance of the problem and presents supporting evidence from three recent studies. Collectively, the findings underscore the need for systematic medication reconciliation processes supported by nurses and interdisciplinary teams to improve patient safety during care transitions.
Practice Problem
Breuker et al. (2021) conducted a prospective observational study of 904 adult hospitalized patients and identified a high rate of unintended medication discrepancies at admission and discharge. The researchers found that 29.4% of patients experienced at least one unintended discrepancy, with 98.2% of these discrepancies classified as medication errors. Omissions accounted for the majority (59.3%) of errors. Furthermore, 36% of the medication errors were rated as serious or very serious, and nearly 40% had the potential for moderate clinical impact. Polypharmacy emerged as a significant risk factor, with error rates increasing in direct relation to the number of medications a patient was taking.
Significance of the Practice Problem
This practice problem is highly significant in contemporary healthcare because medication discrepancies during care transitions contribute to adverse drug events, prolonged hospital stays, avoidable readmissions, and unnecessary financial burden. Nurses routinely obtain medication histories, verify orders, clarify discrepancies with prescribers and pharmacists, and provide discharge education. When reconciliation processes are inconsistent or incomplete, patients, especially those with complex regimens or multiple comorbidities, face a heightened risk of treatment failure or harm.
Breuker et al. (2021) demonstrate that these errors are not isolated events limited to unusual cases; instead, they occur routinely in hospitalized populations. The study shows that medication reconciliation is more than a documentation requirement. It is a fundamental patient safety intervention that depends on vigilant nursing involvement and strong interdisciplinary collaboration.
Supporting Evidence from the Literature
Jošt et al. (2024) performed a pragmatic clinical trial involving 414 adult medical patients to evaluate pharmacist-led medication reconciliation at discharge. Patients receiving the intervention experienced clinically important medication errors at a rate of only 9.3%, compared with 61.9% in the standard-care group. After statistical adjustment, the intervention reduced the odds of a clinically important error by a factor of 20. Although the study did not demonstrate a statistically significant decrease in 30-day healthcare utilization, the marked reduction in discharge errors reinforces the findings of Breuker et al. (2021) and confirms that transition-related medication errors are common yet highly responsive to systematic reconciliation.
Alghamdi et al. (2023) implemented a multicenter quality improvement project across 18 hospitals focused on standardized medication reconciliation at both admission and discharge. The initiative reduced the percentage of patients with at least one outstanding unintentional discrepancy at admission from 27% to 7% and at discharge from 17% to 5%. Documentation compliance within 24 hours also improved significantly. These findings extend Breuker et al. (2021) by showing that the problem is not confined to one setting; rather, medication discrepancies are a systems-level issue that can be meaningfully reduced through standardized workflows, measurable accountability, and interdisciplinary coordination.
Zheng et al. (2024) conducted a prospective quality improvement study of 31 high-risk internal medicine patients at discharge and identified 40 medication errors, with 68% of patients experiencing at least one error and a mean of 1.3 errors per patient. Seventy-five percent of the errors were classified as serious, and 2.5% were potentially life-threatening. Common issues included therapy duplications and medication access barriers, and pharmacist intervention was associated with an estimated cost avoidance of $24,784. This study adds an important economic and harm-prevention perspective to the problem identified by Breuker et al. (2021), demonstrating that discharge discrepancies affect both patient outcomes and organizational resources.
Taken together, the four studies reveal a consistent pattern: medication discrepancies at admission and discharge are prevalent, disproportionately affect patients with polypharmacy, and carry serious clinical and financial consequences. A further point of synthesis is that the studies align on both type and severity of risk: omissions, duplications, and other discrepancies occur most often when medication regimens are complex, and a substantial share of those discrepancies have the potential to cause meaningful harm. Importantly, the literature also shows that the problem is modifiable through structured, team-based reconciliation processes in which nurses remain essential for assessment, communication, patient education, and reinforcement of the discharge plan.
Conclusion
Medication errors and unintended discrepancies at hospital admission and discharge constitute a serious, persistent practice problem that compromises patient safety and healthcare efficiency. Breuker et al. (2021) establish the high prevalence and clinical severity of these errors, particularly omissions in patients with complex medication regimens. Supporting research by Jošt et al. (2024), Alghamdi et al. (2023), and Zheng et al. (2024) reinforces the widespread nature of the issue while showing that targeted reconciliation efforts can substantially reduce error rates. In my professional view, this problem holds particular significance for nursing because nurses maintain continuous proximity to patients and are uniquely positioned to identify discrepancies at the bedside, facilitate interdisciplinary clarification, deliver effective discharge teaching, and assess patient understanding and access to medications. This practice problem is also highly appropriate for the Knowledge-to-Action Framework because the knowledge gap is clear, the intervention is actionable, and the desired outcomes are meaningful for patients, clinicians, and healthcare organizations. Translating the evidence into a sustainable, context-specific medication reconciliation process would provide a strong basis for future implementation and evaluation work.
References
Alghamdi, D. S., Alhrasen, M., Kassem, A., Alwagdani, A., Tourkmani, A. M., Alnowaiser, N., Al Barakah, Y., & Alotaibi, Y. K. (2023). Implementation of medication reconciliation at admission and discharge in Ministry of Defense Health Services hospitals: A multicentre study.
_BMJ Open Quality, 12_(2), Article e002121.
[https://doi.org/10.1136/bmjoq-2022-002121](https://doi.org/10.1136/bmjoq-2022-002121)
Breuker, C., Macioce, V., Mura, T., Castet-Nicolas, A., Audurier, Y., Boegner, C., & Sultan, A. (2021). Medication errors at hospital admission and discharge: Risk factors and impact of medication reconciliation process to improve healthcare.
_Journal of Patient Safety, 17_(7), e645–e652.
[https://doi.org/10.1097/PTS.0000000000000420](https://doi.org/10.1097/PTS.0000000000000420)
Jošt, M., Kerec Kos, M., Kos, M., & Knez, L. (2024). Effectiveness of pharmacist-led medication reconciliation on medication errors at hospital discharge and healthcare utilization in the next 30 days: A pragmatic clinical trial.
_Frontiers in Pharmacology, 15_, 1377781.
[https://doi.org/10.3389/fphar.2024.1377781](https://doi.org/10.3389/fphar.2024.1377781)
Zheng, L., Pon, T., Bajorek, S., Le, K., Hluhanich, R., Ren, Y., & Wilson, M. (2024). Impact of pharmacist-led discharge medication reconciliation on error and patient harm prevention at a large academic medical center.
_Journal of the American College of Clinical Pharmacy, 7_(8), 787–794.
[https://doi.org/10.1002/jac5.1980](https://doi.org/10.1002/jac5.1980)
**## ReducingMedicationErrorsthroughMedicationReconciliationatAdmissionandDischarge.docx**
1
**Reducing Medication Errors through Medication Reconciliation at Admission and Discharge**
Student’s Name
Institutional Affiliation
Course
Instructor
Date
**Reducing Medication Errors through Medication Reconciliation at Admission and Discharge**
Nurses are at the center of practice problem identification, as they are the points where patient needs, system processes, and clinical outcomes meet. Nurses often identify persistent gaps in care provision through direct patient evaluation, medication administration, discharge planning, incident report review, and involvement in quality improvement programs. Medication errors during care transitions are one of the most prevalent and impactful problems in practice that nurses can observe. Admission and discharge times are particularly susceptible as far as medication lists can be either incomplete or obsolete, or the communication can be poor across settings. Such malfunctions subject patients to avoidable injuries and raise the cost of healthcare consumption. This paper examines the practice problem of unintended medication discrepancies and errors at hospital admission and discharge, as identified in Breuker et al. (2021). It discusses the existence and significance of the problem and presents supporting evidence from three recent studies. Collectively, the findings underscore the need for systematic medication reconciliation processes supported by nurses and interdisciplinary teams to improve patient safety during care transitions.
Practice Problem
Breuker et al. (2021) conducted a prospective observational study of 904 adult hospitalized patients and identified a high rate of unintended medication discrepancies at admission and discharge. The researchers found that 29.4% of patients experienced at least one unintended discrepancy, with 98.2% of these discrepancies classified as medication errors. Omissions accounted for the majority (59.3%) of errors. Furthermore, 36% of the medication errors were rated as serious or very serious, and nearly 40% had the potential for moderate clinical impact. Polypharmacy emerged as a significant risk factor, with error rates increasing in direct relation to the number of medications a patient was taking.
Significance of the Practice Problem
This practice problem is highly significant in contemporary healthcare because medication discrepancies during care transitions contribute to adverse drug events, prolonged hospital stays, avoidable readmissions, and unnecessary financial burden. Nurses routinely obtain medication histories, verify orders, clarify discrepancies with prescribers and pharmacists, and provide discharge education. When reconciliation processes are inconsistent or incomplete, patients, especially those with complex regimens or multiple comorbidities, face a heightened risk of treatment failure or harm.
Breuker et al. (2021) demonstrate that these errors are not isolated events limited to unusual cases; instead, they occur routinely in hospitalized populations. The study shows that medication reconciliation is more than a documentation requirement. It is a fundamental patient safety intervention that depends on vigilant nursing involvement and strong interdisciplinary collaboration.
Supporting Evidence from the Literature
Jošt et al. (2024) performed a pragmatic clinical trial involving 414 adult medical patients to evaluate pharmacist-led medication reconciliation at discharge. Patients receiving the intervention experienced clinically important medication errors at a rate of only 9.3%, compared with 61.9% in the standard-care group. After statistical adjustment, the intervention reduced the odds of a clinically important error by a factor of 20. Although the study did not demonstrate a statistically significant decrease in 30-day healthcare utilization, the marked reduction in discharge errors reinforces the findings of Breuker et al. (2021) and confirms that transition-related medication errors are common yet highly responsive to systematic reconciliation.
Alghamdi et al. (2023) implemented a multicenter quality improvement project across 18 hospitals focused on standardized medication reconciliation at both admission and discharge. The initiative reduced the percentage of patients with at least one outstanding unintentional discrepancy at admission from 27% to 7% and at discharge from 17% to 5%. Documentation compliance within 24 hours also improved significantly. These findings extend Breuker et al. (2021) by showing that the problem is not confined to one setting; rather, medication discrepancies are a systems-level issue that can be meaningfully reduced through standardized workflows, measurable accountability, and interdisciplinary coordination.
Zheng et al. (2024) conducted a prospective quality improvement study of 31 high-risk internal medicine patients at discharge and identified 40 medication errors, with 68% of patients experiencing at least one error and a mean of 1.3 errors per patient. Seventy-five percent of the errors were classified as serious, and 2.5% were potentially life-threatening. Common issues included therapy duplications and medication access barriers, and pharmacist intervention was associated with an estimated cost avoidance of $24,784. This study adds an important economic and harm-prevention perspective to the problem identified by Breuker et al. (2021), demonstrating that discharge discrepancies affect both patient outcomes and organizational resources.
Taken together, the four studies reveal a consistent pattern: medication discrepancies at admission and discharge are prevalent, disproportionately affect patients with polypharmacy, and carry serious clinical and financial consequences. A further point of synthesis is that the studies align on both type and severity of risk: omissions, duplications, and other discrepancies occur most often when medication regimens are complex, and a substantial share of those discrepancies have the potential to cause meaningful harm. Importantly, the literature also shows that the problem is modifiable through structured, team-based reconciliation processes in which nurses remain essential for assessment, communication, patient education, and reinforcement of the discharge plan.
Conclusion
Medication errors and unintended discrepancies at hospital admission and discharge constitute a serious, persistent practice problem that compromises patient safety and healthcare efficiency. Breuker et al. (2021) establish the high prevalence and clinical severity of these errors, particularly omissions in patients with complex medication regimens. Supporting research by Jošt et al. (2024), Alghamdi et al. (2023), and Zheng et al. (2024) reinforces the widespread nature of the issue while showing that targeted reconciliation efforts can substantially reduce error rates. In my professional view, this problem holds particular significance for nursing because nurses maintain continuous proximity to patients and are uniquely positioned to identify discrepancies at the bedside, facilitate interdisciplinary clarification, deliver effective discharge teaching, and assess patient understanding and access to medications. This practice problem is also highly appropriate for the Knowledge-to-Action Framework because the knowledge gap is clear, the intervention is actionable, and the desired outcomes are meaningful for patients, clinicians, and healthcare organizations. Translating the evidence into a sustainable, context-specific medication reconciliation process would provide a strong basis for future implementation and evaluation work.
References
Alghamdi, D. S., Alhrasen, M., Kassem, A., Alwagdani, A., Tourkmani, A. M., Alnowaiser, N., Al Barakah, Y., & Alotaibi, Y. K. (2023). Implementation of medication reconciliation at admission and discharge in Ministry of Defense Health Services hospitals: A multicentre study.
_BMJ Open Quality, 12_(2), Article e002121.
[https://doi.org/10.1136/bmjoq-2022-002121](https://doi.org/10.1136/bmjoq-2022-002121)
Breuker, C., Macioce, V., Mura, T., Castet-Nicolas, A., Audurier, Y., Boegner, C., & Sultan, A. (2021). Medication errors at hospital admission and discharge: Risk factors and impact of medication reconciliation process to improve healthcare.
_Journal of Patient Safety, 17_(7), e645–e652.
[https://doi.org/10.1097/PTS.0000000000000420](https://doi.org/10.1097/PTS.0000000000000420)
Jošt, M., Kerec Kos, M., Kos, M., & Knez, L. (2024). Effectiveness of pharmacist-led medication reconciliation on medication errors at hospital discharge and healthcare utilization in the next 30 days: A pragmatic clinical trial.
_Frontiers in Pharmacology, 15_, 1377781.
[https://doi.org/10.3389/fphar.2024.1377781](https://doi.org/10.3389/fphar.2024.1377781)
Zheng, L., Pon, T., Bajorek, S., Le, K., Hluhanich, R., Ren, Y., & Wilson, M. (2024). Impact of pharmacist-led discharge medication reconciliation on error and patient harm prevention at a large academic medical center.
_Journal of the American College of Clinical Pharmacy, 7_(8), 787–794.
[https://doi.org/10.1002/jac5.1980](https://doi.org/10.1002/jac5.1980)
**## KTAAssignmentinstructions.docx**
1. You are going to construct an APA formatted paper for the assignment.
2. Provide an APA formatted title page.
3. Develop an introduction section that includes the professional nurses’ role in using evidence from the literature to address a practice problem.
4. Provide a review of the practice problem and supporting evidence of its existence and significance using the
**original article only** from the Unit 4 literature list (include any suggested edits from the faculty).
5. Search for evidence-based interventions from scholarly literature to address this practice problem and choose ONE from this search that is the best fit for implementation if the problem existed in YOUR CLINICAL PRACTICE
6. Write a Literature Review for your selected intervention supported with three (3) articles.
7. Explain why this is the best evidence-based intervention for your clinical practice setting.
1.
1.
**NOTE**: the three (3) additional articles for the literature review cannot be articles that are referenced in the primary article you selected from the list in Unit 4.
2. Ideally the 3 additional articles discussing this single intervention will have a publication date within the last 5 to 10 years.
3.
Do not do a summary of each intervention individually. Refer to the video on Your First Literature Review for organization of this section.
8. Develop a conclusion section for the paper that summarizes the content and your thoughts about the significance of the using evidence from the literature to address practice problems.
9. Provide an APA formatted reference page and include citations for each source in the body of the assignment where appropriate.
10. The suggested length for this submission, excluding title and reference pages, is no less than 3 pages.
**The assignment requirements include that you upload a file of the full-text article for each listed reference.**
Breuker, C., Macioce, V., Mura, T., Castet-Nicolas, A., Audurier, Y., Boegner, C., &
Sultan, A. (2021). Medication errors at hospital admission and discharge:
Risk factors and impact of medication reconciliation process to improve
healthcare.
Journal of Patient Safety,
17(7), e645-e652.
https://doi.org/10.1097/PTS.0000000000000420
**## ReducingMedicationErrorsthroughMedicationReconciliationatAdmissionandDischarge.docx**
1
**Reducing Medication Errors through Medication Reconciliation at Admission and Discharge**
Student’s Name
Institutional Affiliation
Course
Instructor
Date
**Reducing Medication Errors through Medication Reconciliation at Admission and Discharge**
Nurses are at the center of practice problem identification, as they are the points where patient needs, system processes, and clinical outcomes meet. Nurses often identify persistent gaps in care provision through direct patient evaluation, medication administration, discharge planning, incident report review, and involvement in quality improvement programs. Medication errors during care transitions are one of the most prevalent and impactful problems in practice that nurses can observe. Admission and discharge times are particularly susceptible as far as medication lists can be either incomplete or obsolete, or the communication can be poor across settings. Such malfunctions subject patients to avoidable injuries and raise the cost of healthcare consumption. This paper examines the practice problem of unintended medication discrepancies and errors at hospital admission and discharge, as identified in Breuker et al. (2021). It discusses the existence and significance of the problem and presents supporting evidence from three recent studies. Collectively, the findings underscore the need for systematic medication reconciliation processes supported by nurses and interdisciplinary teams to improve patient safety during care transitions.
Practice Problem
Breuker et al. (2021) conducted a prospective observational study of 904 adult hospitalized patients and identified a high rate of unintended medication discrepancies at admission and discharge. The researchers found that 29.4% of patients experienced at least one unintended discrepancy, with 98.2% of these discrepancies classified as medication errors. Omissions accounted for the majority (59.3%) of errors. Furthermore, 36% of the medication errors were rated as serious or very serious, and nearly 40% had the potential for moderate clinical impact. Polypharmacy emerged as a significant risk factor, with error rates increasing in direct relation to the number of medications a patient was taking.
Significance of the Practice Problem
This practice problem is highly significant in contemporary healthcare because medication discrepancies during care transitions contribute to adverse drug events, prolonged hospital stays, avoidable readmissions, and unnecessary financial burden. Nurses routinely obtain medication histories, verify orders, clarify discrepancies with prescribers and pharmacists, and provide discharge education. When reconciliation processes are inconsistent or incomplete, patients, especially those with complex regimens or multiple comorbidities, face a heightened risk of treatment failure or harm.
Breuker et al. (2021) demonstrate that these errors are not isolated events limited to unusual cases; instead, they occur routinely in hospitalized populations. The study shows that medication reconciliation is more than a documentation requirement. It is a fundamental patient safety intervention that depends on vigilant nursing involvement and strong interdisciplinary collaboration.
Supporting Evidence from the Literature
Jošt et al. (2024) performed a pragmatic clinical trial involving 414 adult medical patients to evaluate pharmacist-led medication reconciliation at discharge. Patients receiving the intervention experienced clinically important medication errors at a rate of only 9.3%, compared with 61.9% in the standard-care group. After statistical adjustment, the intervention reduced the odds of a clinically important error by a factor of 20. Although the study did not demonstrate a statistically significant decrease in 30-day healthcare utilization, the marked reduction in discharge errors reinforces the findings of Breuker et al. (2021) and confirms that transition-related medication errors are common yet highly responsive to systematic reconciliation.
Alghamdi et al. (2023) implemented a multicenter quality improvement project across 18 hospitals focused on standardized medication reconciliation at both admission and discharge. The initiative reduced the percentage of patients with at least one outstanding unintentional discrepancy at admission from 27% to 7% and at discharge from 17% to 5%. Documentation compliance within 24 hours also improved significantly. These findings extend Breuker et al. (2021) by showing that the problem is not confined to one setting; rather, medication discrepancies are a systems-level issue that can be meaningfully reduced through standardized workflows, measurable accountability, and interdisciplinary coordination.
Zheng et al. (2024) conducted a prospective quality improvement study of 31 high-risk internal medicine patients at discharge and identified 40 medication errors, with 68% of patients experiencing at least one error and a mean of 1.3 errors per patient. Seventy-five percent of the errors were classified as serious, and 2.5% were potentially life-threatening. Common issues included therapy duplications and medication access barriers, and pharmacist intervention was associated with an estimated cost avoidance of $24,784. This study adds an important economic and harm-prevention perspective to the problem identified by Breuker et al. (2021), demonstrating that discharge discrepancies affect both patient outcomes and organizational resources.
Taken together, the four studies reveal a consistent pattern: medication discrepancies at admission and discharge are prevalent, disproportionately affect patients with polypharmacy, and carry serious clinical and financial consequences. A further point of synthesis is that the studies align on both type and severity of risk: omissions, duplications, and other discrepancies occur most often when medication regimens are complex, and a substantial share of those discrepancies have the potential to cause meaningful harm. Importantly, the literature also shows that the problem is modifiable through structured, team-based reconciliation processes in which nurses remain essential for assessment, communication, patient education, and reinforcement of the discharge plan.
Conclusion
Medication errors and unintended discrepancies at hospital admission and discharge constitute a serious, persistent practice problem that compromises patient safety and healthcare efficiency. Breuker et al. (2021) establish the high prevalence and clinical severity of these errors, particularly omissions in patients with complex medication regimens. Supporting research by Jošt et al. (2024), Alghamdi et al. (2023), and Zheng et al. (2024) reinforces the widespread nature of the issue while showing that targeted reconciliation efforts can substantially reduce error rates. In my professional view, this problem holds particular significance for nursing because nurses maintain continuous proximity to patients and are uniquely positioned to identify discrepancies at the bedside, facilitate interdisciplinary clarification, deliver effective discharge teaching, and assess patient understanding and access to medications. This practice problem is also highly appropriate for the Knowledge-to-Action Framework because the knowledge gap is clear, the intervention is actionable, and the desired outcomes are meaningful for patients, clinicians, and healthcare organizations. Translating the evidence into a sustainable, context-specific medication reconciliation process would provide a strong basis for future implementation and evaluation work.
References
Alghamdi, D. S., Alhrasen, M., Kassem, A., Alwagdani, A., Tourkmani, A. M., Alnowaiser, N., Al Barakah, Y., & Alotaibi, Y. K. (2023). Implementation of medication reconciliation at admission and discharge in Ministry of Defense Health Services hospitals: A multicentre study.
_BMJ Open Quality, 12_(2), Article e002121.
[https://doi.org/10.1136/bmjoq-2022-002121](https://doi.org/10.1136/bmjoq-2022-002121)
Breuker, C., Macioce, V., Mura, T., Castet-Nicolas, A., Audurier, Y., Boegner, C., & Sultan, A. (2021). Medication errors at hospital admission and discharge: Risk factors and impact of medication reconciliation process to improve healthcare.
_Journal of Patient Safety, 17_(7), e645–e652.
[https://doi.org/10.1097/PTS.0000000000000420](https://doi.org/10.1097/PTS.0000000000000420)
Jošt, M., Kerec Kos, M., Kos, M., & Knez, L. (2024). Effectiveness of pharmacist-led medication reconciliation on medication errors at hospital discharge and healthcare utilization in the next 30 days: A pragmatic clinical trial.
_Frontiers in Pharmacology, 15_, 1377781.
[https://doi.org/10.3389/fphar.2024.1377781](https://doi.org/10.3389/fphar.2024.1377781)
Zheng, L., Pon, T., Bajorek, S., Le, K., Hluhanich, R., Ren, Y., & Wilson, M. (2024). Impact of pharmacist-led discharge medication reconciliation on error and patient harm prevention at a large academic medical center.
_Journal of the American College of Clinical Pharmacy, 7_(8), 787–794.
[https://doi.org/10.1002/jac5.1980](https://doi.org/10.1002/jac5.1980)
**## KTAAssignmentinstructions.docx**
1. You are going to construct an APA formatted paper for the assignment.
2. Provide an APA formatted title page.
3. Develop an introduction section that includes the professional nurses’ role in using evidence from the literature to address a practice problem.
4. Provide a review of the practice problem and supporting evidence of its existence and significance using the
**original article only** from the Unit 4 literature list (include any suggested edits from the faculty).
5. Search for evidence-based interventions from scholarly literature to address this practice problem and choose ONE from this search that is the best fit for implementation if the problem existed in YOUR CLINICAL PRACTICE
6. Write a Literature Review for your selected intervention supported with three (3) articles.
7. Explain why this is the best evidence-based intervention for your clinical practice setting.
1.
1.
**NOTE**: the three (3) additional articles for the literature review cannot be articles that are referenced in the primary article you selected from the list in Unit 4.
2. Ideally the 3 additional articles discussing this single intervention will have a publication date within the last 5 to 10 years.
3.
Do not do a summary of each intervention individually. Refer to the video on Your First Literature Review for organization of this section.
8. Develop a conclusion section for the paper that summarizes the content and your thoughts about the significance of the using evidence from the literature to address practice problems.
9. Provide an APA formatted reference page and include citations for each source in the body of the assignment where appropriate.
10. The suggested length for this submission, excluding title and reference pages, is no less than 3 pages.
**The assignment requirements include that you upload a file of the full-text article for each listed reference.**
Breuker, C., Macioce, V., Mura, T., Castet-Nicolas, A., Audurier, Y., Boegner, C., &
Sultan, A. (2021). Medication errors at hospital admission and discharge:
Risk factors and impact of medication reconciliation process to improve
healthcare.
Journal of Patient Safety,
17(7), e645-e652.
https://doi.org/10.1097/PTS.0000000000000420
**## ReducingMedicationErrorsthroughMedicationReconciliationatAdmissionandDischarge.docx**
1
**Reducing Medication Errors through Medication Reconciliation at Admission and Discharge**
Student’s Name
Institutional Affiliation
Course
Instructor
Date
**Reducing Medication Errors through Medication Reconciliation at Admission and Discharge**
Nurses are at the center of practice problem identification, as they are the points where patient needs, system processes, and clinical outcomes meet. Nurses often identify persistent gaps in care provision through direct patient evaluation, medication administration, discharge planning, incident report review, and involvement in quality improvement programs. Medication errors during care transitions are one of the most prevalent and impactful problems in practice that nurses can observe. Admission and discharge times are particularly susceptible as far as medication lists can be either incomplete or obsolete, or the communication can be poor across settings. Such malfunctions subject patients to avoidable injuries and raise the cost of healthcare consumption. This paper examines the practice problem of unintended medication discrepancies and errors at hospital admission and discharge, as identified in Breuker et al. (2021). It discusses the existence and significance of the problem and presents supporting evidence from three recent studies. Collectively, the findings underscore the need for systematic medication reconciliation processes supported by nurses and interdisciplinary teams to improve patient safety during care transitions.
Practice Problem
Breuker et al. (2021) conducted a prospective observational study of 904 adult hospitalized patients and identified a high rate of unintended medication discrepancies at admission and discharge. The researchers found that 29.4% of patients experienced at least one unintended discrepancy, with 98.2% of these discrepancies classified as medication errors. Omissions accounted for the majority (59.3%) of errors. Furthermore, 36% of the medication errors were rated as serious or very serious, and nearly 40% had the potential for moderate clinical impact. Polypharmacy emerged as a significant risk factor, with error rates increasing in direct relation to the number of medications a patient was taking.
Significance of the Practice Problem
This practice problem is highly significant in contemporary healthcare because medication discrepancies during care transitions contribute to adverse drug events, prolonged hospital stays, avoidable readmissions, and unnecessary financial burden. Nurses routinely obtain medication histories, verify orders, clarify discrepancies with prescribers and pharmacists, and provide discharge education. When reconciliation processes are inconsistent or incomplete, patients, especially those with complex regimens or multiple comorbidities, face a heightened risk of treatment failure or harm.
Breuker et al. (2021) demonstrate that these errors are not isolated events limited to unusual cases; instead, they occur routinely in hospitalized populations. The study shows that medication reconciliation is more than a documentation requirement. It is a fundamental patient safety intervention that depends on vigilant nursing involvement and strong interdisciplinary collaboration.
Supporting Evidence from the Literature
Jošt et al. (2024) performed a pragmatic clinical trial involving 414 adult medical patients to evaluate pharmacist-led medication reconciliation at discharge. Patients receiving the intervention experienced clinically important medication errors at a rate of only 9.3%, compared with 61.9% in the standard-care group. After statistical adjustment, the intervention reduced the odds of a clinically important error by a factor of 20. Although the study did not demonstrate a statistically significant decrease in 30-day healthcare utilization, the marked reduction in discharge errors reinforces the findings of Breuker et al. (2021) and confirms that transition-related medication errors are common yet highly responsive to systematic reconciliation.
Alghamdi et al. (2023) implemented a multicenter quality improvement project across 18 hospitals focused on standardized medication reconciliation at both admission and discharge. The initiative reduced the percentage of patients with at least one outstanding unintentional discrepancy at admission from 27% to 7% and at discharge from 17% to 5%. Documentation compliance within 24 hours also improved significantly. These findings extend Breuker et al. (2021) by showing that the problem is not confined to one setting; rather, medication discrepancies are a systems-level issue that can be meaningfully reduced through standardized workflows, measurable accountability, and interdisciplinary coordination.
Zheng et al. (2024) conducted a prospective quality improvement study of 31 high-risk internal medicine patients at discharge and identified 40 medication errors, with 68% of patients experiencing at least one error and a mean of 1.3 errors per patient. Seventy-five percent of the errors were classified as serious, and 2.5% were potentially life-threatening. Common issues included therapy duplications and medication access barriers, and pharmacist intervention was associated with an estimated cost avoidance of $24,784. This study adds an important economic and harm-prevention perspective to the problem identified by Breuker et al. (2021), demonstrating that discharge discrepancies affect both patient outcomes and organizational resources.
Taken together, the four studies reveal a consistent pattern: medication discrepancies at admission and discharge are prevalent, disproportionately affect patients with polypharmacy, and carry serious clinical and financial consequences. A further point of synthesis is that the studies align on both type and severity of risk: omissions, duplications, and other discrepancies occur most often when medication regimens are complex, and a substantial share of those discrepancies have the potential to cause meaningful harm. Importantly, the literature also shows that the problem is modifiable through structured, team-based reconciliation processes in which nurses remain essential for assessment, communication, patient education, and reinforcement of the discharge plan.
Conclusion
Medication errors and unintended discrepancies at hospital admission and discharge constitute a serious, persistent practice problem that compromises patient safety and healthcare efficiency. Breuker et al. (2021) establish the high prevalence and clinical severity of these errors, particularly omissions in patients with complex medication regimens. Supporting research by Jošt et al. (2024), Alghamdi et al. (2023), and Zheng et al. (2024) reinforces the widespread nature of the issue while showing that targeted reconciliation efforts can substantially reduce error rates. In my professional view, this problem holds particular significance for nursing because nurses maintain continuous proximity to patients and are uniquely positioned to identify discrepancies at the bedside, facilitate interdisciplinary clarification, deliver effective discharge teaching, and assess patient understanding and access to medications. This practice problem is also highly appropriate for the Knowledge-to-Action Framework because the knowledge gap is clear, the intervention is actionable, and the desired outcomes are meaningful for patients, clinicians, and healthcare organizations. Translating the evidence into a sustainable, context-specific medication reconciliation process would provide a strong basis for future implementation and evaluation work.
References
Alghamdi, D. S., Alhrasen, M., Kassem, A., Alwagdani, A., Tourkmani, A. M., Alnowaiser, N., Al Barakah, Y., & Alotaibi, Y. K. (2023). Implementation of medication reconciliation at admission and discharge in Ministry of Defense Health Services hospitals: A multicentre study.
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[https://doi.org/10.1136/bmjoq-2022-002121](https://doi.org/10.1136/bmjoq-2022-002121)
Breuker, C., Macioce, V., Mura, T., Castet-Nicolas, A., Audurier, Y., Boegner, C., & Sultan, A. (2021). Medication errors at hospital admission and discharge: Risk factors and impact of medication reconciliation process to improve healthcare.
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Jošt, M., Kerec Kos, M., Kos, M., & Knez, L. (2024). Effectiveness of pharmacist-led medication reconciliation on medication errors at hospital discharge and healthcare utilization in the next 30 days: A pragmatic clinical trial.
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Zheng, L., Pon, T., Bajorek, S., Le, K., Hluhanich, R., Ren, Y., & Wilson, M. (2024). Impact of pharmacist-led discharge medication reconciliation on error and patient harm prevention at a large academic medical center.
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