Background There is a high risk in transitions of care due to lack of information. There are different strategies to improve quality in patient care and security, as an essential part of it. Patients aged > 65 are a group of high risk with great co-morbidity and polimedication. Medication reconciliation is becaming standard of care in most hospitals. Purpose To determine the feasibility of a reconciliation programme in the Emergency department (ED) at patient discharge. Materials and methods Pilot study carried out over three months in a third level hospital (>1,000 beds). Patients were located in the Observation ward of ED, aged ≥65, suffering from ≥3 diseases and being treated with at least 5 drugs. Before discharge, the Emergency Pharmacist (EP) is asked on electronic request to adjust drug therapy with the most accurate list of out-patient medication. Results The reconciliation process was undertaken in 35 patients: 24 women, 11 men. Mean age 80 years (range 65–92). Average comorbility 6.3 diseases, with renal or hepatic impairment in 11 patients. Drugs reconciliated: 444. Average 12.7 per patient. Discrepancies between ED information at admission and EP review before discharge: 170 (4.9 per patient), 76 omissions (2.2 per patient). 45 drug-related problems with medication taken prior to admission: 14 concerning efficacy and 31, security. Resolved before discharge, 55.6%. 31% remained unresolved waiting for primary care or hospital admission reassessment. A total of 12 patients received written and verbal drug information at discharge, as a result of the reconciliation process. Eight patients out of 12 were provided with a drug therapy report. Updated and accurate drug information electronic record remained available in the medical history after ED discharge. Conclusions Reconciliation at ED discharge is feasible in the Observation ward and may improve drug therapy, preventing adverse drug events at transition points. No conflict of interest.