Detecting Medication Order Discrepancies in Nursing Homes: How RNs and LPNs Differ

Medication order discrepancies pose safety risks when nursing home residents transition between health care settings. In nursing homes, both registered nurses (RNs) and licensed practical nurses (LPNs) frequently are assigned to detect medication order discrepancies, using the process of medication reconciliation. This study was undertaken to examine the extent to which licensure (RN, LPN), years of experience performing medication reconciliation, and the perceived Need for Closure were related to differences in the detection of medication order discrepancies. The Multiple Segment Factorial Vignette design was used to explore and compare nursing home nurses' detection of such discrepancies. RNs (n = 32) and LPNs (n = 70) from 12 Missouri nursing homes responded to four resident transfer vignettes embedded with medication order discrepancies. The study found that years of experience and the Need for Closure were not related to reports of discrepancies. However, RNs detected discrepancies involving orders for high-risk medications significantly more often than LPNs. No significant differences existed between RNs and LPNs when identifying discrepancies in orders for low-risk medications. These findings regarding the discrepancies detected in orders for high-risk medications and those detected in orders for low-risk medications have implications for resident safety.