Medication reconciliation: identifying medication discrepancies in acutely ill hospitalized older adults

Am J Geriatr Pharmacother. 2011 Oct;9(5):339-44. doi: 10.1016/j.amjopharm.2011.07.005. Epub 2011 Sep 3.


Background: Medication discrepancies may occur during transitions from community to acute care hospitals. The elderly are at risk for such discrepancies due to multiple comorbidities and complex medication regimens. Medication reconciliation involves verifying medication use and identifying and rectifying discrepancies.

Objective: The aim of this study was to describe the prevalences and types of medication discrepancies in acutely ill older patients.

Methods: Patients who were ≥ 70 years and were admitted to any of 3 acute care for elders (ACE) units over a period of 2 nonconsecutive months in 2008 were prospectively enrolled. Medication discrepancies were classified as intentional, undocumented intentional, and unintentional. Unintentional medication discrepancies were classified by a blinded rater for potential to harm. This study was primarily qualitative, and descriptive (univariate) statistics are presented.

Results: Sixty-seven patients (42 women; mean [SD] age, 84.0 [6.5] years) were enrolled. There were 37 unintentional prescription-medication discrepancies in 27 patients (40.3%) and 43 unintentional over-the-counter (OTC) medication discrepancies in 19 patients (28.4%), which translates to Medication Reconciliation Success Index (MRSI) of 89% for prescription medications and 59% for OTC medications. The overall MRSI was 83%. More than half of the prescription-medication discrepancies (56.8%) were classified as potentially causing moderate/severe discomfort or clinical deterioration.

Conclusion: Despite a fairly high overall MRSI in these patients admitted to ACE units, a substantial proportion of the prescription-medication discrepancies were associated with potential harm.

MeSH terms

  • Acute Disease
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Aging*
  • British Columbia
  • Comorbidity
  • Female
  • Hospitalization*
  • Hospitals, General
  • Humans
  • Male
  • Medication Errors / prevention & control*
  • Medication Reconciliation*
  • Nonprescription Drugs / adverse effects*
  • Polypharmacy
  • Prescription Drugs / adverse effects*
  • Prospective Studies
  • Risk Assessment
  • Risk Factors


  • Nonprescription Drugs
  • Prescription Drugs