Medication reconciliation improves transition safety

Medication reconciliation during care transitions reduced medication errors, adverse drug events, readmissions, and emergency department visits.
*Mixed-methods systematic review and meta-analysis; Level 2a (OCEBM).

Citation

Feng D, Jin Z, Zou J, et al. Improving Patient Safety Through Medication Reconciliation at Care Transitions: A Mixed Methods Systematic Review. Journal of General Internal Medicine. 2026. doi:10.1007/s11606-026-10376-9

Background

Medication errors are common when patients move between care settings. Medication reconciliation is recommended, but the most effective ways to deliver it have been unclear.

Patients

Patients in 70 controlled studies undergoing care transitions, mainly hospital admission or discharge. Exclusions included non-English studies and studies of community patients only.

Intervention

Structured medication reconciliation programs, often pharmacist-led, using medication history collection, comparison, correction, documentation, and patient or team communication.

Control

Usual care at the study institution.

Outcome

Medication discrepancies, adverse drug events or reactions, readmissions, emergency department visits, death, and length of stay.

Follow-up Period

Most studies followed patients for 30 days; some followed 180 days.

Results

Pooled outcome Effect
Medication discrepancies RR 0.39 (95% CI 0.28 to 0.53)
Adverse drug events or reactions RR 0.61 (95% CI 0.47 to 0.79)
30-day all-cause readmission RR 0.73 (95% CI 0.68 to 0.78)
Emergency department visits RR 0.60 (95% CI 0.52 to 0.68)
Drug-related readmission RR 0.51 (95% CI 0.31 to 0.84)

RR = risk ratio; CI = confidence interval.

Absolute event rates were not pooled, so numbers needed to treat could not be calculated. Pharmacist-led programs and medication reconciliation at hospital admission appeared especially effective. Usual care was the relevant current comparator.

Limitations

Many studies were nonrandomized, and medication discrepancy results were highly variable. Blinding was often impractical. Definitions, settings, and program components differed. Publication bias was possible. Benefits were less clear for 180-day outcomes, death, and length of stay.

Funding

Chinese government research grants; no company funding reported.

Clinical Application

Adopt structured medication reconciliation, preferably pharmacist-led and started at admission, to reduce preventable medication harm during transitions.