International Journal of Clinical Pharmacy

, Volume 33, Issue 4, pp 603–609 | Cite as

Developing a programme for medication reconciliation at the time of admission into hospital

  • Álvaro Giménez Manzorro
  • Ana Clara Zoni
  • Cristina Rodríguez Rieiro
  • Esther Durán-García
  • Alejandro Nicolás Trovato López
  • Cristina Pérez Sanz
  • Patricia Bodas Gutiérrez
  • Ana Belén Jiménez Muñoz


The aim of this article is to describe the methods used to develop the medication reconciliation programme implemented in a tertiary care hospital, and to discuss the main problems encountered and lessons learned during the process. A quasi-experimental study was carried out, analysing discrepancies between routine medication and drugs prescribed in the hospital, before and after an electronic reconciliation tool was introduced at admission. This tool was integrated into the computerized provider order entry system. The implementation of the electronic reconciliation tool has shown a reduction of the rate of discrepancies, decreasing from 7.24% (CI 95% 6.0–8.5) before the intervention to 4.18% (CI 95% 3.2–5.1) afterwards. Projects like this are costly, but this study has made it possible to detect numerous areas where interventions could be useful and proved the importance of a medication reconciliation programme.


Adverse drug events Computerised reconciliation tool Discrepancies Medication error Medication reconciliation Risk management 



We are very grateful for the cooperation and interest of the whole team (Preventive Medicine, General Surgery, Internal Medicine and Pharmacy staff) who took part in the study and development of the programme. It would not have been possible without their help.


The project was funded through a collaborative agreement between the Spanish Ministry of Health and Social Policy and the authorities of the Autonomous Region of Madrid.

Conflicts of interest

None declared.


  1. 1.
    Cornish PL, Knowles SR, Marchesano R, Tam V, Shadowitz S, Juurlink DN, et al. Unintended medication discrepancies at the time of hospital admission. Arch Intern Med. 2005;165(4):424–9.PubMedCrossRefGoogle Scholar
  2. 2.
    Institute for Healthcare Improvement (IHI). Getting started kit: prevention of adverse drug events. Medication reconciliation. How to guide [document on the internet]. IHI; 2007 (cited 20 March 2011). Available from:
  3. 3.
    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):1689–95.PubMedGoogle Scholar
  4. 4.
    Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Medication reconciliation national patient safety goal to be reviewed (document on the internet). JCAHO; 2010 (cited 30 Aug 2010). Available from:
  5. 5.
    World Health Organization (WHO). Collaborating Centre for Patient Safety Solutions. Assuring medication accuracy at transitions in care. Patient safety solutions (document on the internet). WHO; 2007 (cited 30 Aug 2010). Available from:
  6. 6.
    National Institute for Health and Clinical Excellence (NICE) and the National Patient Safety Agency (NSPA). Technical patient safety solutions for medicines reconciliation on admission of adults to hospital (document on the internet). NICE & NSPA; 2007 (cited 30 Nov 2010). Available from:
  7. 7.
    Rozich JD, Howard RJ, Justeson JM, Macken PD, Lindsay ME, Resar RK. Standardization as a mechanism to improve safety in health care. Jt Comm J Qual Saf. 2004;30(1):5–14.PubMedGoogle Scholar
  8. 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):510–5.PubMedCrossRefGoogle Scholar
  9. 9.
    Lessard S, DeYoung J, Vazzana N. Medication discrepancies affecting senior patients at hospital admission. Am J Health Syst Pharm. 2006;63(8):740–3.PubMedCrossRefGoogle Scholar
  10. 10.
    Delgado Sanchez O, Anoz Jimenez L, Serrano Fabia A, Nicolas Pico J. Conciliación de la medicación. Med Clin (Barc). 2007;129(9):343–8.CrossRefGoogle Scholar
  11. 11.
    Anderson HJ. Medication reconciliation: What role will I.T. play? Health Data Manag. 2007;15(7):44, 46, 48.Google Scholar
  12. 12.
    Turchin A, Hamann C, Schnipper JL, Graydon-Baker E, Millar SG, McCarthy PC, et al. Evaluation of an inpatient computerized medication reconciliation system. J Am Med Inform Assoc. 2008;15(4):449–52.PubMedCrossRefGoogle Scholar
  13. 13.
    Bassi J, Lau F, Bardal S. Use of information technology in medication reconciliation: a scoping review. Ann Pharmacother. 2010;44(5):885–97.PubMedCrossRefGoogle Scholar
  14. 14.
    Agrawal A, Wu WY. Reducing medication errors and improving systems reliability using an electronic medication reconciliation system. Jt Comm J Qual Patient Saf. 2009;35(2):106–14.PubMedGoogle Scholar
  15. 15.
    Roure Nuez C, compiler. Documento de consenso en terminología y clasificación de los programas de conciliación de la medicación. 1st ed. Barcelona: Ediciones Mayo; 2009.Google Scholar
  16. 16.
    The National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP). NCC MERP index for categorizing medication errors (document on internet). NCC MERP; 2001 (cited 30 Aug 2010). Available from:

Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  • Álvaro Giménez Manzorro
    • 1
  • Ana Clara Zoni
    • 2
  • Cristina Rodríguez Rieiro
    • 2
  • Esther Durán-García
    • 1
  • Alejandro Nicolás Trovato López
    • 1
  • Cristina Pérez Sanz
    • 1
  • Patricia Bodas Gutiérrez
    • 3
  • Ana Belén Jiménez Muñoz
    • 2
  1. 1.Pharmacy ServiceHospital General Universitario Gregorio MarañónMadridSpain
  2. 2.Preventative Medicine ServiceHospital General Universitario Gregorio MarañónMadridSpain
  3. 3.General Surgery ServiceHospital General Universitario Gregorio MarañónMadridSpain

Personalised recommendations