International Journal of Clinical Pharmacy

, Volume 38, Issue 1, pp 20–24 | Cite as

Effect of teaching and checklist implementation on accuracy of medication history recording at hospital admission

  • Marianne LeaEmail author
  • Ingeborg Barstad
  • Liv Mathiesen
  • Morten Mowe
  • Espen Molden
Short Research Report


Background Medication discrepancies at hospital admission is an extensive problem and knowledge is limited regarding improvement strategies. Objective To investigate the effect of teaching and checklist implementation on accuracy of medication history recording during hospitalization. Method Patients admitted to an internal medicine ward were prospectively included in two consecutive periods. Between the periods, non-mandatory teaching lessons were provided and a checklist assisting medication history recording implemented. Discrepancies between the recorded medications at admission and the patient’s actual drug use, as revealed by pharmacist-conducted medication reconciliation, were compared between the periods. The primary endpoint was difference between the periods in proportion of patients with minimum one discrepancy. Difference in median number of discrepancies was included as a secondary endpoint. Results 56 and 119 patients were included in period 1 (P1) and period 2 (P2), respectively. There was no significant difference in proportion of patients with minimum one discrepancy in P2 (68.9 %) versus P1 (76.8 %, p = 0.36), but a tendency of lower median number of discrepancies was observed in P2 than P1, i.e. 1 and 2, respectively (p = 0.087). Conclusion More powerful strategies than non-mandatory teaching activities and checklist implementation are required to achieve sufficient improvements in medication history recording during hospitalization.


Medication discrepancies Medication history recording Medication reconciliation Norway Patient safety Quality improvement 



The authors thank participating nurses and physicians for their positive attitude and contribution to the study.


Author ML received PhD funding from the South-Eastern Norway Regional Health Authority.

Conflicts of interest


Supplementary material

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Supplementary material 1 (DOCX 72 kb)
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Supplementary material 3 (DOCX 14 kb)


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Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2015

Authors and Affiliations

  • Marianne Lea
    • 1
    Email author
  • Ingeborg Barstad
    • 1
    • 2
  • Liv Mathiesen
    • 3
  • Morten Mowe
    • 4
    • 5
  • Espen Molden
    • 2
    • 6
  1. 1.Department of Pharmaceutical ServicesOslo Hospital PharmacyOsloAustralia
  2. 2.Department of Pharmaceutical Biosciences, School of PharmacyUniversity of OsloOsloAustralia
  3. 3.Hospital Pharmacies Enterprise, South Eastern NorwayOsloAustralia
  4. 4.General Internal Medicine Ward, The Medical ClinicOslo University HospitalOsloAustralia
  5. 5.Faculty of MedicineUniversity of OsloOsloAustralia
  6. 6.Center for PsychopharmacologyDiakonhjemmet HospitalOsloAustralia

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