Medication errors are most likely to occur during admission, transfer, and discharge from hospitals. At discharge, a registered nurse is responsible for medication reconciliation. Previous research has heightened concern for patient safety due to reported transcription errors and omission of medications that occur at time of discharge. A quantitative, descriptive, concurrent research study was performed using a double nurse check of patient medication discharge instructions prior to patient discharge. The sample included 150 medication discharge instructions completed by registered nurses working in a midwestern transitional care unit (TCU). Lewin's Change Theory was the framework used to implement the needed change in procedure for this study, as well as Roy's Adaptation Model. The nurses were educated on medication reconciliation and their role in the importance of educating patients on their prescribed discharge medications prior to the study. A second nurse check of the transcribed discharge medication lists was reviewed for accuracy prior to educating patients at discharge. The research revealed that 18.7% of medication discharge instructions had a medication variance and an 8% medication omission rate, with an overall 25.3% discrepancy rate found on discharge medication instruction sheets. Further research in this area should include the multiple locations for discharge medication instructions in a single patient record on more than one unit at more than one facility. The second nurse check of transcribed discharge medications for verification of prescribed medication orders and transcriptions has the potential to improve discharge medication accuracy and can make a difference in patient safety.