Catching post-discharge medication errors can reduce hospital readmissions

If you or a family member has been hospitalized, the first few days after returning home can be confusing. In fact, let's use the word "risky" when it comes to medication use.

One study showed that about 20% of patients experience adverse events within 3 weeks of discharge, with adverse drug events being the most common problem noted.

What's behind this? Upon discharge, you may have prescriptions to fill for new medicines or need to restart medicines you had at home, but you may not know which ones replace older medicines that should be stopped. In other cases you'll need to take medications in different doses or at different times. You'll already have a lot on your mind, so these changes may cause you to make a mistake as you try to figure out what medicines to take or how to take them now that you are home.

To allay confusion, before you leave the hospital your nurse or pharmacist should reconcile your medication list. They need to meet with you to go over the list of medicines to take at home and compare it to the list of drugs you were taking before being hospitalized. The goal is to help you and your primary care provider gain an understanding about new medications, and what you should and should not be taking any longer. Many hospitals have a pharmacy consulting service where a doctor or nurse can order a "discharge consult" from pharmacy. A pharmacist will arrive and spend time with you to allay potential confusion to reduce the risk of drug-related harm, which increasingly is a reason for patients to be readmitted. This is a valuable service and you should take advantage of it. There's no extra cost.

You'll also need to be told about any pending lab tests and other follow up needs and who to contact in case you have questions. Expect a call post-discharge too, so the hospital can assess how you are doing.

Medicare will soon be penalizing hospitals if they have excessive readmission rates, so it's become increasingly important for them to focus more on what happens after discharge. Also, as part of healthcare reform, the US Department of Health and Human Services has invested $1 billion to launch a program known as "Partnership for Patients," which targets preventable hospital-acquired conditions and seeks to lower readmission rates. I believe this will greatly influence how hospitals work with discharged patients. The Commonwealth of Pennsylvania Patient Safety Authority has also been working with Pennsylvania hospitals to reduce readmissions through sharing best practices for preventing unnecessary readmissions.

In the meantime, if you or a family member is hospitalized, follow these guidelines to avoid making mistakes with your medicines after discharge.

Before discharge, make sure a nurse or pharmacist (re: the discharge consult) comes to your room to review with you clearly written instructions about all the medicines you should take at home. Be sure you know which medicines need a prescription and which can be bought over-the-counter (OTC). Ask them to compare (reconcile) the list of medicines you should take at home to a list of medicines you were taking before you were hospitalized. If you don't have a list with you, your nurse should have a list that you or your family provided upon admission.

Ask your nurse if you should stop or restart any medicines you were taking at home before hospitalization. If a medicine is new, or a dose has changed for a medicine you were previously taking, be sure you receive a new prescription. Ask if the new medicine replaces any medicines you took before being hospitalized. Write down the medicines (including doses and times) you received on the day of discharge. Also write down when you should take the next dose of each medicine on the list. If the directions you are given for taking your medicine include multiple tablets or half tablets, be sure the total dose you should be taking is also provided. For example: Seroquel, two 100 mg tablets (200 mg per dose) daily. Risperdal, half of a 1 mg tablet (0.5 mg per dose) twice daily. Finally, be sure you get the telephone number for the nurses' station so you can call in case you have questions about your medicines during the first few days at home.

After discharge, if you have questions on how to take your medicines, don't hesitate to call your hospital nurse, doctor, or local pharmacist. When filling a new prescription, tell your pharmacist about any OTC medicines, vitamins, or herbals you are taking, as well as any prescription medicines that were stopped. Ask to speak with the pharmacist too, so you can learn as much as possible about any new medicine.

Properly dispose of any older medicines you are no longer taking. If the dose of an existing medicine has been changed, bring the prescription bottle containing the older strength pills to the pharmacy so the directions for use can be updated.

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