Nurse-pharmacist collaboration on medication reconciliation prevents potential harm

Research Topic: 

Leonard Feldman, MD, Linda Costa, PhD, RN, and colleagues examined 563 cases at a large urban hospital in which doctors and nurses both took a medication history from each patient. Nurses reviewed electronic medical records in instances where patients could not recall their medications or the frequency with which they took them. If necessary, nurses also called the patient's family, primary care physician and pharmacists for more information. They compared the resulting lists with admission medication orders to identify discrepancies. The nurses then consulted with a pharmacist, as needed, and informed physicians about any apparently unintentional discrepancies. They followed a similar protocol when patients were discharged.

According to the researchers, the medication lists of nearly 40 percent of patients had at least one unintended discrepancy. Most of these unintended discrepancies were on admission, but the discrepancies with the potential to cause the most harm were more common upon discharge. In addition to providing improved tracking of patients' medication, the researchers concluded that the approach also saved money—costing $114 per identified discrepancy, but saving the hospital thousands of dollars. Researchers calculated that the nurse-pharmacist collaboration saved 81 times the break-even cost for the program.


Feldman, L.S.; Costa, L.L.; Feroli, E.R. Jr; Nelson, T.; Poe, S.S.; Frick, K.D.; Efird, L.E.; Miller, R.G. (2012) "Nurse-pharmacist collaboration on medication reconciliation prevents potential harm.” J Hosp Med. 2012 May-Jun.

Dr. Linda Costa
Dr. Robert Feroli
Grant Year: