RNs More likely to Identify High-Risk Medication Discrepancies

A new study out of University of Missouri caught our attention and deals with an important issue for nurses -safe practices and distinguishing differences in responsibilities.

According to the study, nearly 66 percent of all adverse events experienced by nursing home residents, such as falls, delirium and hallucinations, could be prevented, in part, by monitoring medication more closely. In nursing homes, both registered nurses (RNs) and licensed practical nurses (LPNs) perform medication reconciliation, a safety practice during which health care professionals review patients' medications to reduce the likelihood of preventable adverse drug events.

Researchers at the University of Missouri found that RNs are more likely than LPNs to identify high-risk medication discrepancies, suggesting RNs are better equipped to assess and identify medication errors that could pose risks to residents' safety. The findings suggest the need to distinguish differences in responsibilities for RNs and LPNs in nursing homes, the researchers say.

"Nursing home work is hard," said Amy Vogelsmeier, associate professor at the MU Sinclair School of Nursing. "The ability to manage patients' care and keep them stable is a clinical challenge that requires highly educated, clinically savvy nurses. Currently, RNs are not functioning in nursing homes to the full scope of their practice. RNs and LPNs are assigned the same responsibilities; yet, earlier research findings show that LPNs are more focused on tasks, whereas RNs are more focused on comprehensive assessment and resident safety."

Vogelsmeier and her colleagues examined the extent to which licensure (RN or LPN) relates to the detection of medication discrepancies. Thirty-two RNs and 70 LPNs from 12 nursing homes in Missouri participated in the study. The researchers found that RNs detected medication order discrepancies involving high-risk medications significantly more often than LPNs.

Distinguishing the differences in how RNs and LPNs perform similar responsibilities and making sure nurses complete the tasks for which they are trained could improve patient care for nursing home residents, many of whom are frail and require specialized care, Vogelsmeier said.

"RNs and LPNs contribute to resident safety in different ways," Vogelsmeier said. "They both serve important roles; however, nursing home leaders must understand the distinct contributions of each role. For example, during a process such as medication reconciliation, which is executed differently by RNs and LPNs, understanding the differences will allow for the nurses' different skill-sets to be more appropriately utilized."

After reading through the study's key findings, we want to know what you think. Share your thoughts on this important topic in the comments section below.


  1. I have to disagree depending on the nurse might be a new nurse just from graduation doesn’t even have an idea about medications and they’re putting him in emergency rooms intensive care units yeah I have to disagree with the RNs don’t have all the ability to know all the medications I’m in LBI with 25 years of experience I’ve worked in the intensive care unit I see you nursing homes and I think I have a lot more space and a lot of RNs that are out there theory or not

  2. RNs have more theory vs LPNs who have more bedside training. To work in a nursing home is so hard. LPNs get 30 patients they have to pass meds 7 AM 9 AM 12 PM 2 PM and do treatments on many of the patients in between all the meds. They have to transfer patients right up all the transfer orders. They have MAR us to review every month. They have Falls practically every day not related to overmedication most of the time just related to ataxia. All that and summaries , 10 day notes after admission. Monitor the CNA make sure that they’re doing their job right on their LPNs 30 patient side. All this and only eight hours to do it. A pharmacist comes in and does a consult to check all the meds and make recommendations to nurses but have to call the doctor and resolve these on the charts in on the MARs. Most nursing homes have a RN coordinator to do the care conferences that include social work nutrition and nursing and the patient’s family. Most nursing homes have an MDS coordinator. But sometimes that responsibility falls on the LPN. I dare any RN to do this job day in day out for a month and see how hard it is. Medicare only reimburses a little bit for each patient that’s why the staffing are so poor. But all nurses should know the medications there passing and given to patients. And they do most of them . That includes the higher dosing limitation.


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