Medication reconciliation across admission, transfer and discharge

Transitions change medication information

Admission, ward transfer and discharge can change a patient’s medication list. WHO emphasizes structured processes, capable staff, usable information and partnership with patients and families to improve safety at these transitions. ^[1] Having a list in the record is only a starting point.

Resolve discrepancies

NICE describes reconciliation as establishing an accurate list, comparing it with current medicines, addressing discrepancies and recording changes, including non-prescription and complementary products. ^[2] AHRQ notes that evidence for clinical outcomes is mixed; reconciliation alone should not be promised to reduce readmissions. ^[3]

An ICORP implementation proposal

Assign an owner at each transition and agree how information is verified and unintended differences discussed with the prescriber. Pilot the workflow with one patient group. Make discharge changes visible—what was started, stopped or changed, with the clinical team’s reasons—and ensure patients know whom to contact about uncertainty.

Monitor the process

Sample whether the information source is recorded, discrepancies are resolved and the next team receives the updated list. Separate intentional changes from unintended differences, and review workload and delays. These local improvement suggestions do not set a universal response deadline or guarantee a treatment outcome.