Resolving medication discrepancies.

When elderly patients transition from one health care setting to another they are at increased risk of experiencing fragmented care. One of the most common manifestations of this lack of continuity is medication discrepancy. These differences, such as omission of medications, dosing errors, and duplication of therapy, are a significant safety issue for seniors. This case study describes a 76-year-old woman who is a new resident in an assisted living facility and is referred to the consultant pharmacist for medication review and evaluation of possible adverse drug events. In reviewing the drug regimen, the pharmacist uncovered medication discrepancies; other members of the health care team were unaware of them. These discrepancies may have contributed to some of the patient's current health problems. This case study demonstrates the role of the consultant pharmacist during transitions of care setting and reviews strategies that the pharmacist can use to identify and resolve medication discrepancies.