Volume 6, Issue 6 p. 329-337
Original Research

Medication reconciliation: Barriers and facilitators from the perspectives of resident physicians and pharmacists

Kenneth S. Boockvar MD, MS

Corresponding Author

Kenneth S. Boockvar MD, MS

Geriatrics Research, Education, and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, New York

Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, New York, New York

Jewish Home Lifecare, New York, New York

Telephone: 718-584-9000, ext. 3807

VA Medical Center, 130 West Kingsbridge Road, Bronx, NY 10468Search for more papers by this author
Susan L. Santos PhD

Susan L. Santos PhD

VA New Jersey Health Care System, East Orange, New Jersey

Department of Health Education and Behavioral Science, University of Medicine and Dentistry of New Jersey, New Brunswick, New Jersey

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Andre Kushniruk PhD

Andre Kushniruk PhD

School of Health Information Science, University of Victoria, Victoria, British Columbia, Canada

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Christopher Johnson PhD

Christopher Johnson PhD

Department of Health Policy and Management, Texas A&M Health Science Center, College Station, Texas

VA South Central Mental Illness Research, Education, and Clinical Center, and Houston Center for Quality of Care and Utilization Studies, Michael E. Debakey VA Medical Center, Houston, Texas

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Jonathan R. Nebeker MD

Jonathan R. Nebeker MD

VA Geriatrics Research, Education, and Clinical Center, and University of Utah, Salt Lake City, Utah

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First published: 10 August 2011
Citations: 65

Disclosure: This work was supported by VA Health Services Research and Development Service. Dr. Boockvar is also supported by the Greenwall Foundation. The authors have no conflicts of interest to disclose.



Medication reconciliation can prevent medication errors and harm when patients transition between hospital and other care settings. Though a Joint Commission hospital Patient Safety Goal since 2006, organizations continue to have difficulty implementing the process.


To determine factors that influence performance of medication reconciliation in a hospital setting with a computerized medication reconciliation tool.


Cognitive task analysis (CTA) and focus group interviews.


Urban, academic, tertiary-care Veterans Affairs medical center.


Internal medicine house staff physicians (n = 23) and inpatient staff pharmacists (n = 12).


CTA participants verbalized their thoughts while they completed medication reconciliation with the computerized tool. Focus group participants described medication reconciliation's purpose and effectiveness, how they completed the task, and its barriers and facilitators. Interviews were recorded and analyzed using social science methods for analyzing qualitative data.


Participants agreed that a central goal of medication reconciliation is to prevent prescribing errors, but disagreed about whether it achieves this goal. Computerization facilitated the task, but participants said that computers and patients can be unreliable sources of information. Participants varied in how they sequenced components of the task. When time was limited, physicians considered other responsibilities higher priority. Both physicians and pharmacists expressed low self-efficacy, ie, low perceived capability to achieve the objectives of the process.


Key barriers to medication reconciliation are unreliable sources of medication information and tasks that compete for providers' time and attention that they consider higher priority. Addressing these barriers while increasing providers' self-efficacy might improve medication reconciliation and its outcomes. Journal of Hospital Medicine 2011;6:329–337. © 2011 Society of Hospital Medicine