The implementation of a medication reconciliation intervention including: medication reconciliation on admission and discharge, bedside medication counselling and take-home medication list, on the development of adverse drug events within 30 days post discharge as primary outcome. Secondary outcome is the evaluation of its impact on health care resource utilization

This is a randomized controlled trial in 587 patients randomized to intervention and usual care. The intervention is medication reconciliation on admission and discharge, bedside medication counselling and take-home medication list. Usual care is ward pharmacy practice. The primary outcomes are preventable and potential adverse drug events at 30 days post discharge. The secondary outcome is health care utilization: length of stay, emergency room visits, unplanned hospital visits, readmissions and travel abroad to seek medical attention.

Inclusion Criteria:

• admitted to one of the two medical wards, male and female medical wards.
• was on at least one medication prior to admission
• spoke Arabic or English and can be (the patient or care giver) interviewed for medication history
• stayed in the hospital for at least 24 hours
• discharged on at least one chronic medication or is at least on one chronic medication even if not prescribed upon discharge

Exclusion Criteria:

• could not be interviewed due to language barrier, impaired cognition or other reasons and did not have a care giver
• was under specialties other than medical specialties, but was admitted to medical wards because of lack of beds in their respective wards
• was pregnant
• was already included in the study at a previous admission
• left the hospital against medical advice
• with length of stay of >60 days.