Document Type


Date of Original Version



Pharmacy Practice


Introduction: Medication reconciliation (MR) compares a patient’s self-reported medications with those in their current record or those being ordered to create a complete and accurate medication list.1 Good medication adherence has been associated with a decrease in chronic obstructive pulmonary disease exacerbation (COPDe’s).2

Research Question or Hypothesis: Do discrepancies with COPD medications impact length of stay (LOS) of COPDe’s in Veteran patients ≥ 65?

Study Design: retrospective cohort study

Methods: MRs were completed by pharmacy personnel on the general medicine floor. Inclusion criteria: admitted for COPDe between February 2018-February 2020, able to participate in and had MR performed by pharmacy personnel, Veterans ≥65 years of age, known history of COPD listed in Problem List in electronic medical record, ≥ 1 active or expired medication indicated for COPD, primary discharge diagnosis of COPDe. Exclusion criteria: nursing home patients, not meeting inclusion criteria.

Results: Thirty-two patients met inclusion criteria (mean age = 75). Reasons for discrepancies were poor adherence, change in therapy, duplicate therapy, and not refilled due to adverse drug reaction (56%, 22%, 11%, 11%, respectively). Primary outcomes results were mean LOS 11 (± 26.52) vs 4 (± 2.07) days (p= 0.440 (-25.26, 11.26)) in patients without and with discrepancies, respectively.

Conclusion: Discrepancies related to COPD medications identified through MR did not have a significant impact on LOS in patients admitted for COPD exacerbations. 75% of patients who were readmitted to the hospital for a COPDe within 30 days of discharge had a COPD-related MR discrepancy. Sample size of the study population was not large enough to achieve power as defined in the protocol. Study limitations include strict COPD inclusion criteria, poor problem list documentation, and small sample size. Extreme outliers in length of stay in the patients without MR discrepancies exaggerates the difference between the groups.