Improving Medication Reconciliation at Discharge: A Cross-Sectional Survey

Medication discrepancies remain a persistent patient safety concern despite decades of quality improvement efforts. Research indicates that about half of hospitalized adults experience at least one such discrepancy after discharge, often stemming from unclear clinician roles and poor communication among nurses, physicians, and pharmacists. Understanding nurses' perspectives is critical to designing interventions that will improve medication reconciliation and enhance patient safety at discharge.

This study aimed to explore RNs' perspectives of medication reconciliation during hospital discharge, focusing on barriers, communication patterns, and opportunities for system improvement.

A cross-sectional survey was administered to nursing staff across medical telemetry, cardiac observation, short-stay, and general observation units at a large quaternary academic teaching hospital between March 21 and April 30, 2022. The survey assessed nurses' comfort with patient education, perceived role responsibilities, and collaboration with other disciplines. Quantitative responses were summarized descriptively, and open-ended responses were analyzed using inductive content analysis to identify recurring themes.

Of the 217 nurses invited to participate, 108 completed the survey. Most nurses reported high comfort levels in using teach-back methods (93.5%) and reviewing reconciled medication lists with patients (87%). Responsibility for medication-related discharge tasks was most often viewed as shared, including medication teaching and schedule review as well as communicating medication changes made during hospitalization. Collaboration with pharmacists received the most favorable evaluations, with a majority (60.1%) rating it good or excellent. In contrast, a majority rated as average or worse collaboration with physicians (54.6%), case managers (68.5%), and social workers (63.9%). Free-text responses to open-ended items added further insights.

The study findings indicate that while nurses generally feel confident about their ability to provide patient education, their ability to deliver accurate medication information is hindered by incomplete or inconsistent documentation, role ambiguity, and lapses in interdisciplinary communication. Addressing these issues will require targeted educational interventions, improved interprofessional collaboration, and expanded pharmacy integration. Embedding technological tools such as automated notifications into discharge planning workflows could further improve medication reconciliation and ensure safe care transitions. To achieve these goals, nurses must have accurate medication information, role clarity, and integrated interdisciplinary support.