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Pharmacy 2015, 3(2), 53-71;

Medication Reconciliation at Discharge from Hospital: A Systematic Review of the Quantitative Literature

Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, College Road, Cork, Ireland
Department of Drug Design and Pharmacology Faculty of Health and Medical Sciences, University of Copenhagen, Universitetsparken 2, DK-2100 Copenhagen, Denmark
School of Pharmacy, Queen's University Belfast, Lisburn Road, Belfast, UK
Department of General Practice, Department of General Practice,1st Floor, Brookfield Health Sciences Building, University College Cork, Cork
Department of Pharmacy, Mercy University Hospital, Grenville Place, Cork, Ireland
Author to whom correspondence should be addressed.
Academic Editor: Keith A. Wilson
Received: 6 May 2015 / Revised: 14 May 2015 / Accepted: 9 June 2015 / Published: 23 June 2015
(This article belongs to the Special Issue Medicines across the Interface)
Full-Text   |   PDF [750 KB, uploaded 23 June 2015]   |  


Medicines reconciliation is a way to identify and act on discrepancies in patients’ medical histories and it is found to play a key role in patient safety. This review focuses on discrepancies and medical errors that occurred at point of discharge from hospital. Studies were identified through the following electronic databases: PubMed, Sciences Direct, EMBASE, Google Scholar, Cochrane Reviews and CINAHL. Each of the six databases was screened from inception to end of January 2014. To determine eligibility of the studies; the title, abstract and full manuscript were screened to find 15 articles that meet the inclusion criteria. The median number of discrepancies across the articles was found to be 60%. In average patient had between 1.2–5.3 discrepancies when leaving the hospital. More studies also found a relation between the numbers of drugs a patient was on and the number of discrepancies. The variation in the number of discrepancies found in the 15 studies could be due to the fact that some studies excluded patient taking more than 5 drugs at admission. Medication reconciliation would be a way to avoid the high number of discrepancies that was found in this literature review and thereby increase patient safety. View Full-Text
Keywords: Medication reconciliation; medication errors; medication discrepancies; review Medication reconciliation; medication errors; medication discrepancies; review

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Michaelsen, M.H.; McCague, P.; Bradley, C.P.; Sahm, L.J. Medication Reconciliation at Discharge from Hospital: A Systematic Review of the Quantitative Literature. Pharmacy 2015, 3, 53-71.

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