Journal of General Internal Medicine

, Volume 27, Issue 8, pp 924–932 | Cite as

Effect of Patient- and Medication-Related Factors on Inpatient Medication Reconciliation Errors

  • Amanda H. Salanitro
  • Chandra Y. Osborn
  • Jeffrey L. Schnipper
  • Christianne L. Roumie
  • Stephanie Labonville
  • Daniel C. Johnson
  • Erin Neal
  • Courtney Cawthon
  • Alexandra Businger
  • Anuj K. Dalal
  • Sunil Kripalani
Original Research



Little research has examined the incidence, clinical relevance, and predictors of medication reconciliation errors at hospital admission and discharge.


To identify patient- and medication-related factors that contribute to pre-admission medication list (PAML) errors and admission order errors, and to test whether such errors persist in the discharge medication list.

Design, Participants

We conducted a cross-sectional analysis of 423 adults with acute coronary syndromes or acute decompensated heart failure admitted to two academic hospitals who received pharmacist-assisted medication reconciliation during the Pharmacist Intervention for Low Literacy in Cardiovascular Disease (PILL–CVD) Study.

Main Measures

Pharmacists assessed the number of total and clinically relevant errors in the PAML and admission and discharge medication orders. We used negative binomial regression and report incidence rate ratios (IRR) of predictors of reconciliation errors.

Key Results

On admission, 174 of 413 patients (42%) had ≥1 PAML error, and 73 (18%) had ≥1 clinically relevant PAML error. At discharge, 158 of 405 patients (39%) had ≥1 discharge medication error, and 126 (31%) had ≥1 clinically relevant discharge medication error. Clinically relevant PAML errors were associated with older age (IRR = 1.46; 95% CI, 1.00– 2.12) and number of pre-admission medications (IRR = 1.17; 95% CI, 1.10–1.25), and were less likely when a recent medication list was present in the electronic medical record (EMR) (IRR = 0.54; 95% CI, 0.30–0.96). Clinically relevant admission order errors were also associated with older age and number of pre-admission medications. Clinically relevant discharge medication errors were more likely for every PAML error (IRR = 1.31; 95% CI, 1.19–1.45) and number of medications changed prior to discharge (IRR = 1.06; 95% CI, 1.01–1.11).


Medication reconciliation errors are common at hospital admission and discharge. Errors in preadmission medication histories are associated with older age and number of medications and lead to more discharge reconciliation errors. A recent medication list in the EMR is protective against medication reconciliation errors.


medication reconciliation hospital medication errors admission discharge 



We thank CL Leak, A Munjal, E Swain, KJ Niesner, and C Bass. Grant support: National Heart, Lung and Blood Institute R01 HL089755 to Drs. Kripalani and Schnipper. The funding agency was not involved in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. Dr. Salanitro had full access to all study data and takes responsibility for data integrity and data analysis accuracy. Presented at the Society of General Internal Medicine 34th Annual Meeting in Phoenix, May 6, 2011.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Dr. Kripalani is a consultant to and holds equity in PictureRx, LLC.


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Copyright information

© Society of General Internal Medicine 2012

Authors and Affiliations

  • Amanda H. Salanitro
    • 1
    • 2
  • Chandra Y. Osborn
    • 3
    • 4
  • Jeffrey L. Schnipper
    • 5
    • 6
    • 7
  • Christianne L. Roumie
    • 1
    • 3
    • 4
    • 8
  • Stephanie Labonville
    • 9
  • Daniel C. Johnson
    • 10
  • Erin Neal
    • 10
  • Courtney Cawthon
    • 4
  • Alexandra Businger
    • 5
  • Anuj K. Dalal
    • 5
    • 6
    • 7
  • Sunil Kripalani
    • 2
    • 3
    • 4
  1. 1.Department of Veterans AffairsTennessee Valley Healthcare System Geriatric Research Education and Clinical Center (GRECC)NashvilleUSA
  2. 2.Section of Hospital MedicineVanderbilt UniversityNashvilleUSA
  3. 3.Division of General Internal Medicine and Public HealthVanderbilt UniversityNashvilleUSA
  4. 4.Center for Health Services ResearchVanderbilt UniversityNashvilleUSA
  5. 5.Division of General Medicine and Primary CareBrigham and Women’s HospitalBostonUSA
  6. 6.BWH Hospitalist ServiceBrigham and Women’s HospitalBostonUSA
  7. 7.Harvard Medical SchoolBostonUSA
  8. 8.Department of PediatricsVanderbilt UniversityNashvilleUSA
  9. 9.Department of Pharmacy ServicesBrigham and Women’s HospitalBostonUSA
  10. 10.Department of Pharmaceutical ServicesVanderbilt University Medical CenterNashvilleUSA

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