Impact of Pharmacist-led Medication Reconciliation in Hospitals: A Systematic Review

Abstract

Medication errors during critical transition points in patient care—such as hospital admissions, intra-hospital transfers, and discharges—remain a significant challenge to ensuring patient safety and optimal therapeutic outcomes. Pharmacist-led medication reconciliation programs have emerged as a pivotal strategy to mitigate these errors by systematically reviewing and verifying patients’ medication histories, identifying discrepancies, and facilitating accurate communication among healthcare providers. This systematic review integrates findings from eight peer-reviewed studies that evaluated the impact of pharmacist-led medication reconciliation interventions across diverse hospital environments, including tertiary care, teaching hospitals, and specialized units. The evidence consistently demonstrates that these interventions lead to a substantial reduction in medication discrepancies, enhanced patient safety, improved adherence to prescribed therapy, and strengthened interdisciplinary collaboration. Moreover, the review highlights various implementation strategies, methodological approaches, and outcome measures that contribute to the effectiveness of these programs. The findings underscore the importance of incorporating pharmacist-led medication reconciliation into standard hospital practice and provide actionable recommendations for broader adoption to optimize patient care and minimize medication-related risks.