Medication reconciliation: ineffective or hard to implement?

In this issue of BMJ Quality & Safety, Schnipper et al evaluate the implementation of a multifaceted medication reconciliation intervention at six hospitals using the MARQUIS medication reconciliation implementation toolkit.1 The planned intervention included the following elements: hiring or reallocating new staff to obtain medication histories, performing both admission and discharge medication reconciliation, improving access to preadmission medication sources, introducing policy, training staff on obtaining medication histories and patient counselling, implementing a gold standard medication reconciliation process including targeting of high-risk patients, improving healthcare information technology and utilising social marketing and community engagement. The study had many methodological strengths, including independent observers for outcome verification, clinical assessment of medication discrepancies, pragmatic implementation in both community and teaching hospitals, mentored implementation and a large randomly selected patient sample with controls and temporal trending. The main result was that potentially harmful discrepancies did not decrease over time beyond baseline...

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