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Medication Reconciliation at Discharge: A Review of the Clinical Evidence and Guidelines

Last updated: April 9, 2012
Project Number: RC0339-000
Product Line: Rapid Response
Research Type: Devices and Systems
Report Type: Summary with Critical Appraisal
Result type: Report


  1. What is the clinical evidence regarding the process of medication reconciliation at patient discharge?
  2. What are the evidence-based guidelines regarding the role of health care professionals in the process of medication reconciliation at patient discharge?

Key Message

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.