European Journal of Clinical Pharmacology

, Volume 70, Issue 11, pp 1325–1332 | Cite as

Should nurses or clinical pharmacists perform medication reconciliation? A randomized controlled trial

  • Trine Aag
  • Beate Hennie GarciaEmail author
  • Kirsten K. Viktil
Clinical Trial



To study differences in outcomes of medication reconciliation (MR) when performed by clinical pharmacists compared to nurses.


201 patients (21–92 years) admitted to the Department of Cardiology at the University Hospital of North Norway, autumn 2012, were randomized into a pharmacist group (PG) and a nurse group (NG). The nurses and the pharmacists were trained for performing the MR process by an independent clinical pharmacist. Medication discrepancies (MDs) were discussed with the physicians. Time spent during the MR was recorded. An independent expert group rated clinical relevance of the MDs retrospectively.


At least one MD was identified in 78 % and 84 % of patients in PG and NG, respectively (P = 0.269) with a mean number of MDs per patient 3.1 (SD 2.1) and 2.8 (SD 2.2), respectively (P = 0.528). Mean time spent/patient on the MR process was 22.9 min (SD 11.6) in the PG and 32.2 min (SD 20.3) in the NG (P < 0,001). Physicians agreed significantly more often to act upon the MDs presented by pharmacists compared to nurses (P = 0.001). The expert group finally assessed 48 % and 49 % of the MDs to be of the clinical relevance in the PG and the NG, respectively.


By applying a structured method for MR, a small however not statistically significant difference in identified MDs between nurses and clinical pharmacists was revealed. The pharmacists spent significantly less time than the nurses, and physicians agreed significantly more often with the pharmacist that action should be taken on the MDs. This is important in the discussion of who to perform MR.


Medication reconciliation randomized controlled trial clinical pharmacist nurse integrated medicines management (IMM) 



We thank the personnel and patients at the Department of Cardiology at the University hospital of North Norway for all help and collaboration, especially the tree nurses that participated; Jeanette Robertsen, Jenny Vesterhus and Katrine Vollen. We thank MD Richard Slubowski for the help in validating the English-Norwegian translation of clinical relevance criteria and the expert group for rating clinical relevance. We thank Sykehusapotekene i Midt-Norge HF for teaching, help and collaboration regarding the IMM methodology and IMM tools.

Conflict of interest

The authors declare that they have no conflicts of interest to disclose.

Supplementary material

228_2014_1741_MOESM1_ESM.docx (34 kb)
ESM 1 (DOCX 33 kb)


  1. 1.
    Tam VC, Knowles SR, Cornish PL, Fine N, Marchesano R, Etchells EE (2005) Frequency, type and clinical importance of medication history errors at admission to hospital: a systematic review. CMAJ 173(5):510–515PubMedCrossRefPubMedCentralGoogle Scholar
  2. 2.
    Scullin C, Scott M, Hogg A, McElnay J (2007) An innovative approach to integrated medicines management. J Ev Clin Pract 13(5):781–788CrossRefGoogle Scholar
  3. 3.
    Steurbaut S, Leemans L, Leysen T, De BE, Cornu P, Mets T et al (2010) Medication history reconciliation by clinical pharmacists in elderly inpatients admitted from home or a nursing home. Ann Pharmacother 44(10):1596–1603PubMedCrossRefGoogle Scholar
  4. 4.
    Midlov P, Bergkvist A, Bondesson A, Eriksson T, Hoglund P (2005) Medication errors when transferring elderly patients between primary health care and hospital care. Pharm World Sci 27(2):116–120PubMedCrossRefGoogle Scholar
  5. 5.
    Garasen H, Johnsen R (2007) The quality of communication about older patients between hospital physicians and general practitioners: a panel study assessment. BMC Health Serv Res 7:133PubMedCrossRefPubMedCentralGoogle Scholar
  6. 6.
    Glintborg B, Andersen SE, Dalhoff K (2007) Insufficient communication about medication use at the interface between hospital and primary care. Qual Saf Health Care 16(1):34–39PubMedCrossRefPubMedCentralGoogle Scholar
  7. 7.
    Unroe KT, Pfeiffenberger T, Riegelhaupt S, Jastrzembski J, Lokhnygina Y, Colon-Emeric C (2010) Inpatient medication reconciliation at admission and discharge: A retrospective cohort study of age and other risk factors for medication discrepancies. Am J Geriatr Pharmacother 8(2):115–126PubMedCrossRefPubMedCentralGoogle Scholar
  8. 8.
    Salanitro AH, Osborn CY, Schnipper JL, Roumie CL, Labonville S, Johnson DC et al (2012) Effect of patient- and medication-related factors on inpatient medication reconciliation errors. J Gen Intern Med 27(8):924–932PubMedCrossRefPubMedCentralGoogle Scholar
  9. 9.
    Mueller SK, Sponsler KC, Kripalani S, Schnipper JL (2012) Hospital-based medication reconciliation practices: a systematic review. Arch Intern Med 172(14):1057–1069PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Feldman LS, Costa LL, Feroli ER Jr, Nelson T, Poe SS, Frick KD et al (2012) Nurse-pharmacist collaboration on medication reconciliation prevents potential harm. J Hosp Med 7(5):396–401PubMedCrossRefGoogle Scholar
  11. 11.
    The American Society of Health-System Pharmacists (ASHP) (2013) ASHP statement on the pharmacist’s role i medication reconciliation. Am J Health Syst Pharm 70(5):453–456CrossRefGoogle Scholar
  12. 12.
    Randomization service from the Norwegian University of Science and Technology. Accessed 2014-03-25
  13. 13.
    Eriksson T, Holmdahl L, Bondesson Å, Midlov P, Høglund P (2010) Medicin och farmaci i samverkan för bättre läkemedelsansvändning: LIMM-modellen. [Eng. Medicine and Pharmacy in collaboration for better use of medicines: The LIMM-model]. I vården 9:23–27Google Scholar
  14. 14.
    Norwegian Institute of Public Health. WHO collaboration centre for drug statistics and methodology. Accessed 2014-03-25
  15. 15.
    Cornish PL, Knowles SR, Marchesano R, Tam V, Shadowitz S, Juurlink DN et al (2005) Unintended medication discrepancies at the time of hospital admission. Arch Intern Med 165(4):424–429PubMedCrossRefGoogle Scholar
  16. 16.
    Robson C (2002) Real world research. A resource for social scientists and practitioner-researchers, 2nd edn. Blackwell Publishing, MaldenGoogle Scholar
  17. 17.
    Jones J, Hunter D (1995) Consensus methods for medical and health services research. BMJ 311(7001):376–380PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    National Institute for Health and Clinical Excellence (2011) Technical patient safety solutions for medicines reconciliation on admission of adults to hospital. NICE patient safety guidance. Accessed 2014-03-25Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Trine Aag
    • 1
  • Beate Hennie Garcia
    • 1
    • 2
    Email author
  • Kirsten K. Viktil
    • 3
    • 4
  1. 1.Hospital Pharmacy of North Norway TrustTromsøNorway
  2. 2.Department of Pharmacy, Faculty of Health SciencesUniversity of TromsøTromsøNorway
  3. 3.School of PharmacyThe Faculty of Mathematics and Natural SciencesOsloNorway
  4. 4.Diakonhjemmet Hospital PharmacyOsloNorway

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