Medication reconciliation at patient admission: a randomized controlled trial

  • Antonio E. Mendes
  • Natália F. Lombardi
  • Vânia M. Andrzejevski
  • Gibran Frandoloso
  • Cassyano J. Correr
  • Maurício Carvalho
Keywords: Medication Reconciliation, Pharmaceutical Services, Randomized Controlled Trials as Topic, Brazil


Objective: To measure length of hospital stay (LHS) in patients receiving medication reconciliation. Secondary characteristics included analysis of number of preadmission medications, medications prescribed at admission, number of discrepancies, and pharmacists interventions done and accepted by the attending physician.

Methods: A 6 month, randomized, controlled trial conducted at a public teaching hospital in southern Brazil. Patients admitted to general wards were randomized to receive usual care or medication reconciliation, performed within the first 72 hours of hospital admission.

Results: The randomization process assigned 68 patients to UC and 65 to MR. LHS was 10±15 days in usual care and 9±16 days in medication reconciliation (p=0.620). The total number of discrepancies was 327 in the medication reconciliation group, comprising 52.6% of unintentional discrepancies. Physicians accepted approximately 75.0% of the interventions.

Conclusion: These results highlight weakness at patient transition care levels in a public teaching hospital. LHS, the primary outcome, should be further investigated in larger studies. Medication reconciliation was well accepted by physicians and it is a useful tool to find and correct discrepancies, minimizing the risk of adverse drug events and improving patient safety.


Download data is not yet available.

Author Biographies

Antonio E. Mendes

Internal Medicine Department - Clinical Pharmacy Service

RPh, Pharmacist 

Natália F. Lombardi

Pharmaceutical Sciences Department

RPh, Pharmacist

Vânia M. Andrzejevski

Clinics Hospital - Hospital Pharmacy Unit

RPh, Pharmacist

Gibran Frandoloso

Internal Medicine Department

MD, Auxiliar Professor 

Cassyano J. Correr

Pharmaceutical Sciences Department

Pharm PhD, Adjunct Professor 

Maurício Carvalho

Internal Medicine Department

MD PhD, Adjunct Professor 


1. Bodenheimer T. Coordinating care--a perilous journey through the health care system. N Engl J Med. 2008;358(10):1064-1071. doi: 10.1056/NEJMhpr0706165

2. Coleman EA, Berenson RA. Lost in transition: challenges and opportunities for improving the quality of transitional care. Ann Intern Med. 2004;141(7):533-536.

3. Kripalani S, Jackson AT, Schnipper JL, Coleman EA. Promoting effective transitions of care at hospital discharge: a review of key issues for hospitalists. J Hosp Med. 2007;2(5):314-323.

4. Makaryus AN, Friedman EA. Patients’ understanding of their treatment plans and diagnosis at discharge. Mayo Clin Proc. 2005;80(8):991-994.

5. Calkins DR, Davis RB, Reiley P, Phillips RS, Pineo KL, Delbanco TL, Iezzoni LI. Patient-physician communication at hospital discharge and patients’ understanding of the postdischarge treatment plan. Arch Intern Med. 1997;157(9):1026-1030.

6. Pàez Vives F, Recha Sancho R, Altadill Amposta A, Montaña Raduà RM, Anadón Chortó N, Castells Salvadó M. [An interdisciplinary approach to reconciling chronic medications on admission to Mora d'Ebre local hospital]. Rev Calid Asist. 2010;25(5):308-313. doi: 10.1016/j.cali.2010.03.002

7. Pippins JR, Gandhi TK, Hamann C, Ndumele CD, Labonville SA, Diedrichsen EK, Carty MG, Karson AS, Bhan I, Coley CM, Liang CL, Turchin A, McCarthy PC, Schnipper JL. Classifying and predicting errors of inpatient medication reconciliation. J Gen Intern Med. 2008;23(9):1414-1422. doi: 10.1007/s11606-008-0687-9

8. Tam VC, Knowles SR, Cornish PL, Fine N, Marchesano R, Etchells EE. Frequency, type and clinical importance of medication history errors at admission to hospital: a systematic review. CMAJ. 2005;173(5):510-515.

9. Coleman EA, Smith JD, Raha D, Min S. Posthospital medication discrepancies: prevalence and contributing factors. Arch Intern Med. 2005;165(16):1842-1847.

10. The Audit Commission. A spoonful of sugar. Medicines management in NHS hospitals. [Internet]. Available from: (accessed March 1, 2015).

11. Delgado Sánchez O, Anoz Jiménez L, Serrano Fabiá A, Nicolás Pico J. Conciliation in medication. Med Clin (Barc). 2007;129(9):343-348.

12. Paparella S. Medication reconciliation: doing what’s right for safe patient care. J Emerg Nurs. 2006;32(6):516-520.

13. Resources JC. Using medication reconciliation to prevent errors. Jt Comm J Qual Patient Saf. 2006;32(4):230-232.

14. Saufl NM. Reconciliation of medications. J Perianesth Nurs. 2006;21(2):126-127.

15. Manno MS, Hayes DD. Best-practice interventions: how medication reconciliation saves lives. Nursing. 2006;36(3):63-64.

16. Rotta I, Salgado TM, Felix DC, Souza TT, Correr CJ, Fernandez-Llimos F. Ensuring consistent reporting of clinical pharmacy services to enhance reproducibility in practice: an improved version of DEPICT. J Eval Clin Pract. 2015;21(4):584-590. doi: 10.1111/jep.12339

17. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373-383.

18. Dooley MJ, Allen KM, Doecke CJ, Galbraith KJ, Taylor GR, Bright J, Carey DL. A prospective multicentre study of pharmacist initiated changes to drug therapy and patient management in acute care government funded hospitals. Br J Clin Pharmacol. 2004;57(4):513-521.

19. Tompson AJ, Peterson GM, Jackson SL, Hughes JD, Raymond K. Utilizing community pharmacy dispensing records to disclose errors in hospital admission drug charts. Int J Clin Pharmacol Ther. 2012;50(9):639-646. doi: 10.5414/CP201720

20. Salanitro AH, Osborn CY, Schnipper JL, Roumie CL, Labonville S, Johnson DC, Neal E, Cawthon C, Businger A, Dalal AK, Kripalani S. Effect of patient- and medication-related factors on inpatient medication reconciliation errors. J Gen Intern Med. 2012;27(8):924-932. doi: 10.1007/s11606-012-2003-y

21. Duguid M. The importance of medication reconciliation for patients and practioners. Aust Prescr. 2012;35:15-19.

22. Cornish PL, Knowles SR, Marchesano R, Tam V, Shadowitz S, Juurlink DN, Etchells EE. Unintended medication discrepancies at the time of hospital admission. Arch Intern Med. 2005;165(4):424-429.

23. Gleason KM, Groszek JM, Sullivan C, Rooney D, Barnard C, Noskin GA. Reconciliation of discrepancies in medication histories and admission orders of newly hospitalized patients. Am J Health Syst Pharm. 2004;61(16):1689-1695.

24. Vira T, Colquhoun M, Etchells E. Reconcilable differences: correcting medication errors at hospital admission and discharge. Qual Saf Health Care. 2006;15(2):122-126.

25. Lubowski TJ, Cronin LM, Pavelka RW, Briscoe-Dwyer LA, Briceland LL, Hamilton RA. Effectiveness of a medication reconciliation project conducted by PharmD students. Am J Pharm Educ. 2007;71(5):94.

26. Gleason KM, McDaniel MR, Feinglass J, Baker DW, Lindquist L, Liss D, Noskin GA. Results of the Medications at Transitions and Clinical Handoffs (MATCH) study: an analysis of medication reconciliation errors and risk factors at hospital admission. J Gen Intern Med. 2010;25(5):441-447. doi: 10.1007/s11606-010-1256-6

27. Beckett RD, Crank CW, Wehmeyer A. Effectiveness and feasibility of pharmacist-led admission medication reconciliation for geriatric patients. J Pharm Pract. 2012;25(2):136-141. doi: 10.1177/0897190011422605
Original Research

Most read articles by the same author(s)