A guide for medication management at hospital discharge

Pharmacists encounter complications with hospital discharge prescriptions almost on a daily basis. Missing information, discrepancies from patient’s previous therapy, potential interactions to confirm with the doctor, clarifications on the last dose given at the hospital, and the list goes on.

Not surprisingly, information tends to get miscommunicated or lost when passed through many different hands and these complications result in a lot of stress and wasted time for the caregiver.

The pharmacist also struggles in chasing down relevant doctors and nurses in the hospital to collect the information needed to properly prepare the medication.

During a hospital discharge, as a caregiver, you are likely overwhelmed with information from different healthcare professionals. Whether it is the first or a recurrent admission for the person in your care, it probably feels stressful each time. But it doesn’t have to be.

Managing the discharge prescription and ensuring a smooth transition of medication therapy in the community setting can in fact be simple if you have a guide that helps you ask the important questions and record the important information. It also facilitates communication and clarification, and ultimately helps reduce stress and wait times.

Form A: Leaving the hospital checklist

Category	Fill in here	Notes
Hospital info	Floor: Department:
Attending physician	Number: Page:
Attending pharmacist	Number: Extension:
Attending nurse	Number: Extension:
Follow up appointment set up:	Who: Date:
Follow-up care instructions
Discharge prescriptions	Time of last dose given: Changes made:
Lab/test results