The Impact of Medication Reconciliation on Continuityof Drug Therapy during Perioperative Period

Cover Page

Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access


Background. Medication errors and resultant adverse drug events (ADEs) often occur during transitions of care. Up to 67% of in-patients’ prescriptions have at least one unintentional medication discrepancy with previously prescribed therapy. The proportion of clinically significant medication discrepancies is 11–59%. Studies from the developed countries demonstrated the effectiveness of medication reconciliation in reducing medication errors, ADEs and healthcare resource utilization. There is a necessity to conduct medication reconciliation studies within Russian current clinical practice to develop effective medical care quality and patients’ safety programs. Aims — to evaluate the impact of pharmacologist-led medication reconciliation on the frequency and structure of unintentional medication discrepancies and potential ADEs at hospital admission and discharge. Methods. Standard care was compared to medication reconciliation led by a clinical pharmacologist in a prospective randomized trial of 410 elective surgical patients. Medication discrepancies at hospital admission and discharge were identified and reconciled. Clinical outcomes were evaluated by reviewing electronic health records. Results. In the intervention group the frequency of unintentional discrepancies at hospital admission decreased from 32.68 to 16.86%, the proportion of patients with at least one unintentional discrepancy decreased from 64.9 to 44.9%, the number of discrepancies per patient decreased from 1.5 to 0.66. The incidence of discrepancies at hospital discharge decreased from 82.90 to 43.29%, the proportion of patients with discrepancies decreased from 95.61 to 52.68%, the average number of discrepancies per patient decreased from 2.79 to 1.67. Medication reconciliation led by clinical pharmacologist decreased the frequency of unscheduled out-patient visits after discharge from 7.32 to 2.93%. The determined risk factors for unintentional discrepancies at hospital admission were: prescribing of cardiovascular, endocrine drugs and those affecting the central nervous system. Both at admission and discharge medication reconciliation was the significant factor reducing the risk of unintentional discrepancies. Conclusions. Medication reconciliation at hospital admission and discharge reduces the frequency of unintentional discrepancies in drug prescriptions by 16 and 40%, respectively. The implementation of medication reconciliation into clinical practice reduces unscheduled out-patient visits after hospital discharge.

Full Text

Restricted Access

About the authors

Maria D. Nigmatkulova

Russian Medical Academy of Continuing Professional Education; General Medical Center of the Bank of Russia

ORCID iD: 0000-0001-8840-4904
SPIN-code: 2263-3980

graduate student, clinical pharmacologist

Russian Federation, 66, Sevastopolskij ave., Moscow, 117647; 2/1, Barrikadnaya st., Moscow, 125993

E. B. Kleymenova

General Medical Center of the Bank of Russia; Russian Medical Academy of Continuing Professional Education; Federal Research Center «Computer Science and Control» of the Russian Academy of Sciences

ORCID iD: 0000-0002-8745-6195
SPIN-code: 2037-7164


Russian Federation, 66, Sevastopolskii ave., Moscow, 117647; 2/1, Barrikadnaya st., Moscow, 125993; 44-2, Vavilova str., Moscow, 119333

Liubov P. Yashina

General Medical Center of the Bank of Russia; Federal Research Center «Computer Science and Control» of the Russian Academy of Sciences

ORCID iD: 0000-0003-1357-0056
SPIN-code: 1910-0484

PhD in Biology

Russian Federation, 66, Sevastopolskii ave., Moscow, 117647; 125993; 44-2, Vavilova str., Moscow, 119333

Dmitry A. Sychev

Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of the Russian Federation

Author for correspondence.
ORCID iD: 0000-0002-4496-3680
SPIN-code: 4525-7556

MD, PhD, Professor, Corresponding Member of the RAS

Russian Federation, 2/1, Barrikadnaya st., Moscow, 125993


  1. Mueller SK, Sponsler KC, Kripalani S, et al. Hospital-based medication reconciliation practices: A systematic review. Arch Intern Med. 2012;172(14):1057–1069. doi:
  2. Kwan JL, Lo L, Sampson M, et al. Medication reconciliation during transitions of care as a patient safety strategy: A systematic review. Ann Intern Med. 2013;158(5Pt2):397–403. doi:
  3. Tam VC, Knowles SR, Cornish PL, et al. Frequency, type and clinical importance of medication history errors at admission to hospital: A systematic review. CMAJ. 2005;173(5):510–515. doi:
  4. Climente-Martí M, García-Mañón ER, Artero-Mora A, et al. Potential risk of medication discrepancies and reconciliation errors at admission and discharge from an inpatientmedical service. Ann Pharmacother. 2010;44(11):1747–1754. doi:
  5. Cornu P, Steurbaut S, Leysen T, et al. Effect of medication reconciliation at hospital admission on medication discrepancies during hospitalization and at discharge. Ann Pharmacother. 2012;46(4):484–494. doi:
  6. Mazhar F, Akram S, Al-Osaimi YA, et al. Medication reconciliation errors in a tertiary care hospital in Saudi Arabia: Admission discrepancies and risk factors. Pharm Pract (Granada). 2017;15(1):864. doi:
  7. de Vries EN, Prins HA, Crolla RMPH, et al. Effect of a comprehensive surgical safety system on patient outcomes. N Engl J Med. 2010;363(20):1928–1937. doi:
  8. Joint Commission on Accreditation of Healthcare Organizations. Using medication reconciliation to prevent errors. Jt Comm J Qual Patient Saf. 2006;32(4):230–232. doi:
  9. Australian Commission on Safety and Quality in Healthcare. Medication reconciliation. Available from: http://www.safetyandquality.
  10. Canadian Council on Health Services Accreditation. Required Organizational Practices (ROP) Handbook 2020. Available from:
  11. WHO Collaborating Centre for Patient Safety. The High 5s Project — Standard Operating Protocol for Medication Reconciliation. Assuring Medication Accuracy at Transitions in Care. WHO, 2014. 36 p. Available from:
  12. Mekonnen AB, McLachlan AJ, Brien J-A. Pharmacy-led medication reconciliation programmes at hospital transitions: A systematic review and meta-analysis. J Clin Pharm Ther. 2016;41(2):128–144. doi:
  13. Cheema E, Alhomoud FK, Kinsara ASA, et al. The impact of pharmacists-led medicines reconciliation on healthcare outcomes in secondary care: A systematic review and meta-analysis of randomized controlled trials. PLoS One. 2018;13(3):e0193510. doi:
  14. Mekonnen AB, Abebe TB, McLachlan AJ, et al. Impact of electronic medication reconciliation interventions on medication discrepancies at hospital transitions: a systematic review and meta-analysis. BMC Med Inform Decis Mak. 2016;16(1):112. doi:
  15. Schnipper JL, Hamann C, Ndumele CD, et al. Effect of an electronic medication reconciliation application and process redesign on potential adverse drug events: A cluster-randomized trial. Arch Intern Med. 2009;169(8):771–780. doi:
  16. Pippins JR, Gandhi TK, Hamann C, et al. Classifying and predicting errors of inpatient medication reconciliation. J Gen Intern Med. 2008;23(9):1414–1422. doi:
  17. NCC MERP Index for Categorizing Medication Errors. 1996, Revised: February 20, 2001. Available from: (accessed: 02.08.2021).
  18. Murphy EM, Oxencis CJ, Klauck JA, et al. Medication reconciliation at an academic medical center: implementation of a comprehensive program from admission to discharge. Am J Health Syst Pharm. 2009;66(23):2126–2131. doi:
  19. Al-Hashar A, Al-Zakwani I, Eriksson T, et al. Impact of medication reconciliation and review and counselling, on adverse drug events and healthcare resource use. Int J Clin Pharm. 2018;40(5):1154–1164. doi:

Supplementary files

There are no supplementary files to display.

Copyright (c) 2022 "Paediatrician" Publishers LLC

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies