Results of the Medications At Transitions and Clinical
Handoffs (MATCH) Study: An Analysis of Medication
Reconciliation Errors and Risk Factors at Hospital Admission
Kristine M. Gleason, RPh
, Molly R. McDaniel, PharmD
, Joseph Feinglass, PhD
David W. Baker, MD, MPH
, Lee Lindquist, MD, MPH
, David Liss, MA
and Gary A. Noskin, MD
Division of Quality and Operations, Department of Clinical Quality Management, Northwestern Memorial Hospital, Chicago, IL, USA;
of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA;
Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, IL, USA;
Division of Infectious Diseases, Department of
Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA;
Pharmacy and Clinical Performance, Sanford Health, Sioux
Falls, SD, USA;
Department of Health Services, University of Washington School of Public Health, Seattle, WA, USA;
Hospital, Chicago, IL, USA.
BACKGROUND: This study was designed to determine
risk factors and potential harm associated with medi-
cation errors at hospital admission.
METHODS: Study pharmacist and hospital-physician
medication histories were compared with medication
orders to identify unexplained history and order dis-
crepancies in 651 adult medicine service inpatients
with 5,701 prescription medications. Discrepancies
resulting in order changes were considered errors.
Logistic regression was used to analyze the association
of patient demographic and clinical characteristics
including patients’ number of pre-admission prescrip-
tion medications, pharmacies, prescribing physicians
and medication changes; and presentation of medica-
tion bottles or lists. These factors were tested after
controlling for patient demographics, admitting service
and severity of illness.
RESULTS: Over one-third of study patients (35.9%)
experienced 309 order errors; 85% of patients had
errors originate in medication histories, and almost half
were omissions. Cardiovascular agents were commonly
in error (29.1%). If undetected, 52.4% of order errors
were rated as potentially requiring increased monitor-
ing or intervention to preclude harm; 11.7% were rated
as potentially harmful. In logistic regression analysis,
patient’s age≥65 [odds ratio (OR), 2.17; 95% confidence
interval (CI), 1.09–4.30] and number of prescription
medications (OR, 1.21; 95% CI, 1.14–1.29) were signif-
icantly associated with errors potentially requiring
monitoring or causing harm. Presenting a medication
list (OR, 0.35; 95% CI, 0.19–0.63) or bottles (OR, 0.55;
95% CI, 0.27–1.10) at admission was beneficial.
CONCLUSION: Over one-third of the patients in our
study had a medication error at admission, and of these
patients, 85% had errors originate in their medication
histories. Attempts to improve the accuracy of medica-
tion histories should focus on older patients with a large
number of medications. Primary care physicians and
other clinicians should help patients utilize and main-
tain complete, accurate and understandable medica-
KEY WORDS: medication reconciliation; medication errors; medication
J Gen Intern Med 25(5):441–7
© Society of General Internal Medicine 2010
btaining medication histories among hospitalized
patients is an error-prone process.
the quality and completeness of medication histories at the
time of hospital admission include language and cultural
barriers, which can be compounded by multiple prescribing
physicians or use of multiple pharmacies due to economic,
insurance and/or convenience factors.
Older patients taking a large number of medications may
not recall indications or doses. Look-alike/sound-alike medi-
cations increase the risk of inaccurate histories, especially if
patients are unclear about the rationale for use.
their surrogates with low health literacy may be poor histor-
ians or may withhold medication compliance information.
Clinician time constraints and interview skills may also affect
the quality of medication histories. Even medication lists in
electronic medical records (EMR) can lag behind prescription
changes and be incomplete.
This prospective study was designed to identify and analyze
the frequency and types of admission medication errors in our
hospital’s medicine service. Ratings for each error’s potential
for patient harm during hospitalization are presented. Finally,
the complex association of medication errors with individual
patient risk factors was analyzed.
Received July 18, 2009
Revised December 2, 2009
Accepted January 6, 2010
Published online February 24, 2010