Inadequate Medication Reconciliation in Hospitals

Study Focus

This peer-reviewed qualitative study explores why medication reconciliation on hospital admission was often inadequate, even where procedures already existed. The focus is on the experiences of doctors and nurses and how organisational routines, communication, and responsibility affected patient safety.

Purpose and Design

The purpose of the study was to gain insight into doctors’ and nurses’ experiences with medication reconciliation when patients were admitted to hospital. The study used one-on-one qualitative interviews with staff from emergency and medical wards, aiming to understand how the process worked in practice and where it broke down.

Main Findings

• Staff agreed that medication reconciliation is important for patient safety.
• The process was still experienced as inadequate and difficult to implement.
• Clinicians often relied on multiple information sources, and these were not always reliable or consistent.
• Staff were often uncertain whether the medication information reflected actual patient use.
• The allocation of responsibility was unclear, especially across professions and wards.
• Communication was inadequate between the person gathering medication information and the doctor responsible for assessing and documenting it.
• Transfer of medication information between the emergency ward and medical wards was not always effective.

Why the Process Was Inadequate

The study suggests that problems did not come from one single cause. Instead, inadequacy resulted from a combination of unreliable medication sources, lack of standardised routines, unclear task allocation, and weak communication pathways. Medication reconciliation was not considered complete until the information had been assessed by a doctor and transferred into the patient record, so any failure in handover or documentation could undermine the whole process.

Implications for Practice

• Standardise tasks in the medication reconciliation process.
• Improve communication between nurses, doctors, and wards.
• Assign responsibility more clearly so roles are not ambiguous.
• Support staff with training and learning concepts, including how to assess medication sources critically and communicate effectively with patients.
• Strengthen documentation and handover systems so medication information follows the patient accurately.

Strengths and Limitations

A strength of the study is that it included perspectives from both doctors and nurses working in relevant hospital settings. A limitation is that interview data provide indirect evidence about what happens in practice; observation or focus groups might have revealed more about actual collaboration during reconciliation.

Key Takeaway

The study concludes that medication reconciliation in hospitals can remain inadequate even when procedures exist, unless organisations also ensure reliable information sources, clear responsibilities, effective communication, and standardised routines.

Source: [Field Research Methods: Quantitative Approaches](material:123)