Medication Reconciliation at Admission

Best Practices

Created on November 19, 2015

Evidence-informed best practices are based on quality evidence and should be implemented into practice to optimize outcomes. Listed below you will find best practices graded according to the type of evidence. To view a description of the types of evidence, click here.

To help you move from best evidence to best practice, click on the + button next to each best practice to find details on how to implement, as well as change ideas to test using a PDSA approach. 

Change ideas are specific and practical changes by experience and research that focus on improving specific aspects of a system, process or behaviour. To learn more about change ideas see the QI: Getting Started tab.


Created on November 19, 2015

How will we know if a change is an improvement? Measurement is one of the critical steps in a quality improvement (QI) initiative that assesses the impact of your tests of change. There are three types of quality indicators used to measure your QI efforts: outcome (indicators that capture clinical outcomes and or system performance), process (indicators that track the processes that measure whether the system is working as planned), and balancing indicators (indicators that ensure that changing one part of the system does not cause new problems in other parts of the system).

Quality indicators are used to measure how well something is performing. Just as a physician might measure a person's cholesterol to find out how healthy he or she is, quality indicators are used to determine how well the Ontario health system and home care providers are meeting the needs of their clients. Health Quality Ontario (HQO) reports on some home care indicators which allow comparisons between Community Care Access Centres (CCACs) and comparisons over time. Quality indicators can also be used by home care providers to assess whether the changes they are implementing have led to improvements.

Quality indicators for measuring medication reconciliation and the impact of strategies to improve medication reconciliation.

Type of Indicator Indicator of Quality Improvement How to Calculate:


Targets/ Benchmarks How is This Indicator Used?
Outcome The total number of patients with medications reconciled as a proportion of the total number of patients admitted to the hospital Total number of patients with medications reconciled
Total number of patients admitted to the hospital
Targets: Theoretical best 100%

Provincial benchmarks:
not available
Quality improvement

QIP indicator

Run Charts

Collected measures can be presented graphically by plugging the monthly results into run chart.

Tools & Resources

Created on November 19, 2015


For a more comprehensive list of tools and resources, visit the following links on our HQO website:



Created on November 19, 2015

“Right now we spend a lot of time trying to diagnose what is wrong with the patient, yet often miss the fact that there is a medication-related problem. This means that patients often go home still on a medication which may be causing harm.”
Dr. Corinne Hohl, Associate Professor, Faculty of Emergency Medicine – University of British Columbia


Admission into the hospital can result in a patient receiving new medications or having changes made to their existing medications. The Institute of Safe Medication Practices describes medication reconciliation as a formal process in which healthcare providers work together with patients, families and care providers to ensure accurate and comprehensive medication information is communicated consistently across transitions of care including hospital admissions.1 Medication reconciliation is a systematic and comprehensive review of all the medications a patient is taking, including prescription and non-prescription drugs, to ensure that medications being added, changed or discontinued are carefully evaluated.1 As a component of medication management, it informs prescribers in making the most appropriate prescribing decisions for the patient. 1

Call to Action:

Acquiring complete information about all medications, including what is being taken as well as how the patient is taking them, guards against potential adverse events and it endevours to prevent medication errors at transition points in patients care. Medication reconciliation at care transitions has been recognized as a best practice and is increasingly becoming a system-wide standard. All hospitals should be working towards comprehensive implementation of medication reconciliation. In 2012, practice leaders from 50 organizations in Canada were surveyed to identify success factors to implementation of a medication reconciliation initiative and identified the following success factors:

  • Strong leadership support
  • Physician champions/leaders,
  • Strong information technology support, and
  • Comprehensive staff education plan2
  1. Institute for Safe Medication Practices Canada.

    Medication Reconciliation.
    Available from: https://www.ismp-canada.org/medrec

  2. Institute for Safe Medication Practices Canada; Canadian Patient Safety Institute.

    National Medication Reconciliation Strategy. Identifying Practice Leaders for Medication Reconciliation in Canada. 2012.
    Available from: http://www.ismp-canada.org/download/MedRec/Identifying_Practice_Leaders_for_Medication_Reconciliation_in_Canada.pdf