Skip Navigation
Medication Reconciliation
Download: Adobe Reader    Email icon Email      Print icon Print

Background

Patients often receive new medications or have changes made to their existing medications at times of transitions in care—upon hospital admission, transfer from one unit to another during hospitalization, or discharge from the hospital to home or another facility. Although most of these changes are intentional, unintended changes occur frequently for a variety of reasons. For example, hospital-based clinicians might not be able to easily access patients' complete pre-admission medication lists, or may be unaware of recent medication changes. As a result, the new medication regimen prescribed at the time of discharge may inadvertently omit needed medications, unnecessarily duplicate existing therapies, or contain incorrect dosages. These discrepancies place patients at risk for adverse drug events (ADEs), which have been shown to be one of the most common types of adverse events after hospital discharge.

More than half of patients have ‚Č• 1 unintended medication discrepancy at hospital admission. 61% of these discrepancies had no harm potential; 33% had moderate harm potential; and 6% had severe harm potential.

Source: Cornish PL, Knowles SR, Marchesano R, et al. Unintended medication discrepancies at the time of hospital admission. Arch Intern Med. 2005;165:424-429. [go to PubMed]

Accomplishing Medication Reconciliation

The evidence supporting patient benefits from reconciling medications is relatively scanty. Most medication reconciliation interventions have focused on attempting to prevent medication errors at hospital admission or discharge, but the most effective and generalizable strategies remain unclear. A 2012 systematic review of 26 inpatient medication reconciliation studies found some evidence that pharmacist-led processes could prevent medication discrepancies and potential ADEs after discharge, a finding corroborated by a 2013 systematic review published as part of the AHRQ Making Healthcare Safer II report. However, both these reviews noted that the actual clinical effect of medication discrepancies after discharge appears to be small, and therefore, medication reconciliation alone does not reduce readmissions or other adverse events after discharge.

Information technology solutions are being widely studied and also appear to prevent unintended medication discrepancies, but their effect on clinical outcomes is similarly unclear. This may be in part due to the fact that medication discrepancies can persist even in organizations with fully integrated electronic medical records. Several recent studies also investigated the role of enhanced patient engagement in medication reconciliation in the outpatient setting and after hospital discharge. These efforts are promising but also lack evidence regarding the impact on medication error rates.

Current Context

Medication reconciliation was named as 2005 National Patient Safety Goal #8 by the Joint Commission. The Joint Commission's announcement called on organizations to "accurately and completely reconcile medications across the continuum of care." In 2006, accredited organizations were required to "implement a process for obtaining and documenting a complete list of the patient's current medications upon the patient's admission to the organization and with the involvement of the patient" and to communicate "a complete list of the patient's medications‚Ķto the next provider of service when a patient is referred or transferred to another setting, service, practitioner or level of care within or outside the organization."

The Joint Commission suspended scoring of medication reconciliation during on-site accreditation surveys between 2009 and 2011. This policy change was made in recognition of the lack of proven strategies for accomplishing medication reconciliation. As of July 2011, medication reconciliation has been incorporated into National Patient Safety Goal #3, "Improving the safety of using medications." This National Patient Safety Goal requires that organizations "maintain and communicate accurate medication information" and "compare the medication information the patient brought to the hospital with the medications ordered for the patient by the hospital in order to identify and resolve discrepancies."

 
What's New in Medication Reconciliation on AHRQ PSNet
Editor's Picks for Medication Reconciliation
From AHRQ WebM&M
Reconciling Records.
Hardeep Singh, MD, MPH; Dean F. Sittig, PhD; Maureen Layden, MD, MPH. AHRQ WebM&M [serial online]. November 2010
Medication Reconciliation Pitfalls.
Robert J. Weber, PharmD, MS. AHRQ WebM&M [serial online]. February 2010
Medication Reconciliation Victory after an Avoidable Error.
Timothy W. Cutler, PharmD. AHRQ WebM&M [serial online]. February/March 2009
Hospital Admission Due to High-Dose Methotrexate Drug Interaction.
Lydia C. Siegel, MD; Tejal K. Gandhi, MD, MPH. AHRQ WebM&M [serial online]. January 2009
Integrating Multiple Medication Decision Support Systems: How Will We Make It All Work?.
Josh Peterson, MD, MPH. AHRQ WebM&M [serial online]. May 2008
Medication Reconciliation: Whose Job Is It?
Eric G. Poon, MD, MPH. AHRQ WebM&M [serial online]. September 2007
Reconciling Doses.
Frank Federico, RPh. AHRQ WebM&M [serial online]. November 2005
 
From AHRQ PSNet
JOURNAL ARTICLE
Engaging patients in medication reconciliation via a patient portal following hospital discharge.
Heyworth L, Paquin AM, Clark J, et al. J Am Med Inform Assoc. 2014;21:e157-e162.
Medication reconciliation during transitions of care as a patient safety strategy: a systematic review.
Kwan JL, Lo L, Sampson M, Shojania KG. Ann Intern Med. 2013;158(5 Pt 2):397-403.
 Classic iconEffect of a pharmacist intervention on clinically important medication errors after hospital discharge: a randomized trial.
Kripalani S, Roumie CL, Dalal AK, et al; PILL-CVD (Pharmacist Intervention for Low Literacy in Cardiovascular Disease) Study Group. Ann Intern Med. 2012;157:1-10.
 Classic iconHospital-based medication reconciliation practices: a systematic review.
Mueller SK, Sponsler KC, Kripalani S, Schnipper JL. Arch Intern Med. 2012;172:1057-1069.
 Classic iconAssociation of ICU or hospital admission with unintentional discontinuation of medications for chronic diseases.
Bell CM, Brener SS, Gunraj N, et al. JAMA. 2011;306:840-847.
 Classic iconEffect of an electronic medication reconciliation application and process redesign on potential adverse drug events: a cluster-randomized trial.
Schnipper JL, Hamann C, Ndumele CD, et al. Arch Intern Med. 2009;169:771-780.
A comprehensive pharmacist intervention to reduce morbidity in patients 80 years or older: a randomized controlled trial.
Gillespie U, Alassaad A, Henrohn D, et al. Arch Intern Med. 2009;169:894-900.
 Classic iconRole of pharmacist counseling in preventing adverse drug events after hospitalization.
Schnipper JL, Kirwin JL, Cotugno MC, et al. Arch Intern Med. 2006;166:565-571.
 Classic iconUnintended medication discrepancies at the time of hospital admission.
Cornish PL, Knowles SR, Marchesano R, et al. Arch Intern Med. 2005;165:424-429.
TOOLS/TOOLKIT
Medications at Transitions and Clinical Handoffs (MATCH) Toolkit for Medication Reconciliation.
Gleason KM, Brake H, Agramonte V, Perfetti C. Rockville, MD: Agency for Healthcare Research and Quality; Revised August 2012. AHRQ Publication No. 11(12)-0059.
Safety Information for Patients and Families.
The Massachusetts Coalition for the Prevention of Medical Errors.
WEB RESOURCE
National Patient Safety Goals.
Oakbrook Terrace, IL: The Joint Commission; 2014.
LEGISLATION/REGULATION
Using medication reconciliation to prevent errors.
Sentinel Event Alert. January 25, 2006;(35):1-4.
BOOK/REPORT
 Classic iconPreventing Medication Errors: Quality Chasm Series.
Committee on Identifying and Preventing Medication Errors, Aspden P, Wolcott J, Bootman JL, Cronenwett LR, eds. Washington, DC: The National Academies Press; 2007.
Medication Reconciliation Handbook.
Oakbrook Terrace, IL: Joint Commission Resources and the American Society of Health-System Pharmacists; 2006. ISBN: 0866889566.
 
Last Updated: December 2014