Medication Reconciliation at Transitions of Care: A Multidisciplinary Review of Patient Safety in Emergency, Inpatient, and Community Settings

Medication reconciliation is widely recognized as a core patient-safety strategy because transitions of care are periods in which medication histories, current orders, and patient understanding frequently diverge. These discrepancies may lead to omitted chronic therapies, unintended duplications, dosing errors, inappropriate continuation of acute treatments, therapeutic confusion after discharge, and preventable adverse drug events. The topic has broad relevance to pharmacists, pharmacy technicians, clinical pharmacists, nurses, emergency medical services personnel, public health workers, social workers, and other professionals involved in continuity of care because the process of obtaining, verifying, reconciling, communicating, and monitoring medicine-related information is inherently multidisciplinary. The present review was designed to mimic the structure and scientific logic of established review articles on medication reconciliation and transitions of care while extending the discussion to the practical contributions of multiple professions across the care continuum. The review synthesizes guideline-level recommendations, systematic reviews, and representative hospital and emergency department studies on medication reconciliation. Existing evidence shows that medication discrepancies are common at admission, intra-hospital transfer, and discharge, particularly among older adults, patients with polypharmacy, those with multimorbidity, and patients moving through emergency and post-acute care settings. Systematic reviews have consistently shown that medication reconciliation reduces unintended discrepancies in medication lists, yet evidence for downstream effects on hard clinical outcomes such as readmission is more mixed when reconciliation is implemented as a stand-alone activity rather than as part of a broader transitional-care program. This distinction is crucial for designing scientifically sound and operationally realistic service models. The review discusses definitions, epidemiology, settings of application, profession-specific responsibilities, emergency department and emergency medical services interfaces, nursing and social work roles, barriers to implementation, use of information technology, quality indicators, and future directions. The literature supports a model in which medication reconciliation is not treated as a clerical obligation but as a structured safety intervention linked to pharmaceutical care, discharge planning, patient education, and continuity of care. Such a model permits appropriate task sharing: technicians can collect and document best possible medication histories, pharmacists and clinicians can interpret and resolve discrepancies, nurses can reinforce adherence and discharge understanding, and social and public health professionals can address access, health literacy, and post-discharge continuity. Medication reconciliation therefore remains one of the strongest multidisciplinary review topics for publication in the areas of pharmaceutical care, emergency medicine, nursing practice, and patient safety.