International Journal of Clinical Pharmacy

, Volume 38, Issue 5, pp 1164–1171 | Cite as

Prevalence and risk factors for medication reconciliation errors during hospital admission in elderly patients

  • Blanca Rodríguez VargasEmail author
  • Eva Delgado Silveira
  • Irene Iglesias Peinado
  • Teresa Bermejo Vicedo
Research Article


Background Care transitions are risk points for medication discrepancies, especially in the elderly. Objective This study was undertaken to assess prevalence and describe medication reconciliation errors during admission in elderly patients and to analyze associated risk factors. We also evaluate the effect of these errors on the length of hospital stay. Setting General surgery, orthopedics, internal medicines and infectious diseases departments of a 1070-bed Spanish teaching hospital. Method This is a prospective observational study. Patients >65 years and taking ≥5 medications were randomly selected from those admitted to hospital. The pharmacist obtained the best possible medication history based on medical records, medical notes from patients’ previous admissions to hospital, “brown bag” review, community care prescriptions, and comprehensive patient interviews. It was compared to current inpatient prescription to detect unintentional discrepancies (discrepancy with no apparent clinical explanation), which were reported to the physician. When the physician accepted the discrepancy by changing the medication order, it was recorded as a medication reconciliation error and classified by type of error. Several variables were analyzed as possible risk/protective factors. Main outcome measure Is prevalence of medication reconciliation errors at admission. Results Reconciliation was performed on 206 patients. Medication reconciliation errors occurred in 49.5 % (102/206) of patients. 1996 medications were recorded, and 359 had unintentional discrepancies (56.0 % (201/359) medication reconciliation errors). The most common was omission (65.1 %). Identified risk factors were as follows: physician experience, number of pre-admission prescribed medications, and previous surgeries. Computerized order entry system was a protective factor. Conclusion Medication reconciliation errors occur in almost half of the elderly patients at admission, especially omissions. Risk factors were a larger number of previous medications, less physician years of experience, and more previous surgeries. Having a computerized order entry system in the hospital protected against some errors.


Adverse drug event Aged Medication error Medication reconciliation Patient admission Spain 



We would like to thank Justino Rodríguez Vargas, patients, caregivers, physicians, nurses, and pharmacists of the Ramon y Cajal University Health Centre for their collaboration to this study.



Conflicts of interest



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Copyright information

© Springer International Publishing 2016

Authors and Affiliations

  • Blanca Rodríguez Vargas
    • 1
    Email author
  • Eva Delgado Silveira
    • 1
  • Irene Iglesias Peinado
    • 2
  • Teresa Bermejo Vicedo
    • 1
  1. 1.Pharmacy DepartmentRamon y Cajal HospitalMadridSpain
  2. 2.Complutense UniversityMadridSpain

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