- What is the clinical evidence regarding the process of medication reconciliation at patient discharge?
- What are the evidence-based guidelines regarding the role of health care professionals in the process of medication reconciliation at patient discharge?
A high number of medication discrepancies occur at discharge affecting a substantial proportion of patients, with omissions in medications representing the most common type of discrepancy noted at discharge. There is a lack of evidence on the effectiveness of medication reconciliation as a specific strategy conducted at discharge. No guidelines were identified that made specific recommendations on which member(s) of the clinical team should preferentially perform medication reconciliation.