Discharged but Not Safe: Medication Errors and Preventable Harm after Hospital Discharge in Older Adults

Abstract

This critical integrative review examined how medication-related failures developed between inpatient prescribing and post-discharge use in older adults, and why process improvements did not consistently translate into fewer emergency visits or readmissions. Medication safety was weakened not only by unintended discrepancies but also when purposeful changes lost their rationale, instructions were poorly understood in the context of medicines already present at home, or follow-up responsibility remained unclear. Reconciliation and pharmacist-led interventions improved medication accuracy more consistently than broad health-service outcomes because readmission lay far downstream from the mechanisms these interventions targeted. The review proposed a post-discharge medication continuity gap, defined as a break between an intended hospital medication decision and its preservation long enough for appropriate reassessment. The concept extended beyond list discrepancy because technically correct documentation could still fail in communication or home use. It was presented as an analytical proposition rather than a validated clinical construct. Safer discharge depended on medication decisions remaining transferable, clinically intelligible, and recoverable when later care began to diverge.