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PS-084 Medicines reconciliation on admission and risk factors for error
  1. B Rodríguez Vargas1,
  2. E Delgado Silveira1,
  3. I Iglesias Peinado2,
  4. T Bermejo Vicedo1
  1. 1Hospital Ramón y Cajal, Pharmacy Department, Madrid, Spain
  2. 2Universidad Complutense. Facultad de Farmacia, Pharmacology Department, Madrid, Spain


Background Transitions of care are high risk points for medicines errors, so that medicines reconciliation is essential for improving drug safety. It consists of identifying the most accurate list of the patient’s medicines and comparing it to the current list in use, in order to identify any discrepancies.

Purpose To assess the incidence and predictors of medicines reconciliation errors (MRE) at hospital admission.

Materials and methods This prospective study included patients >65 years with polypharmacy (≥5 drugs). All patients were interviewed by a pharmacist within 24 h of hospital admission. Any differences in medicines that were not caused by changes in clinical condition or adaption to the hospital’s drug formulary were defined as unintended discrepancies. Whenever the physician changed the prescription we considered MRE.

To identify factors associated with MRE a univariate and a stepwise binary logistic regression analysis were performed. Categorical variables were compared by using the chi-squared test, and continuous variables using the nonparametric Mann–Whitney U test (p < 0.05).

Results 206 patients were included. Mean age (±SD) was 79.6 ± 7.2 years. 56% were male. Unintended discrepancies occurred in 70.4% of patients. 201 MRE were observed. 49.5% of patients had at least one error and mean MRE/patient was 1.0 ± 1.3.

Univariate analysis identified as potential risk factors, number of drugs at admission, number of previous surgical procedures, and number of clinical diagnoses at admission. In multivariate analysis, number of drugs and physician experience were the only independent risk factors. Electronic prescription was confirmed as a protective factor.

Polypharmacy has been previously reported to increase MRE.1 Although data are scarce other authors also suggest that physician experience would influence MRE.2

Conclusions MRE affect nearly half of patients. Number of drugs and prescription by less experienced physicians were risk factors. Interestingly, electronic prescribing contributes to reducing MRE. Efforts should be focused on patients with polypharmacy and related educational campaigns should target junior medical staff.


  1. Gleason KM, McDaniel MR, Feinglass J, Baker DW, Lindquist L, Liss D et al. 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): 441-7.

  2. Pippins JR, Gandhi TK, Hamann C, Ndumele CD, Labonville SA, Diedrichsen EK, et al. Classifying and predicting errors of inpatient medication reconciliation. Gen Intern Med 2008;23(9):1414-22.

No conflict of interest.

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