Hospital-to-home medication transitions — the dangerous handoff

This article provides information about medication transitions from hospital to home. Always verify medication lists, ask questions about changes, and consult your elder's primary doctor if anything seems unclear.

Your father spent three days in the hospital for pneumonia. He's getting better and is ready to be discharged. The hospital gives you a list of medications to take home. You look at the list. It doesn't match the medications he was taking before admission. Some old medications are gone. Some new ones have been added. You're not sure what's supposed to happen. Welcome to one of the most dangerous transitions in healthcare: hospital to home medication changes.

Hospital admissions often result in medication changes. Hospitals might add medications for the acute problem. They might stop medications that interact with new treatments. They might change doses. Some changes are necessary. Some are oversights. Some are never communicated back to the patient or outpatient doctor.

The dangers of this transition are real. Your father might go home with medications nobody explained. He might not understand why an old medication was stopped. He might not know how to take new medications. He might not know about side effects. He might not realize that stopping a medication abruptly is dangerous.

Sometimes discharged patients have confusion about instructions. One list says take the medication three times daily. Another says twice daily. Which is right? A medication label says avoid food, but another medication must be taken with food. How do you manage that?

The biggest danger is when important information gets lost. Maybe the hospital started your father on a new blood thinner. Maybe this isn't communicated to his outpatient cardiologist. Maybe the cardiologist starts different blood thinning therapy not knowing about the hospital medication. Maybe your father accidentally takes both.

Another danger is when medications are duplicated. Your father was on a blood pressure medication at home. The hospital started a different one. Now he goes home on both. His blood pressure drops dangerously. Nobody realized he should stop one of them.

What can you do to prevent these problems? Start by getting a clear medication list before your elder leaves the hospital. Ask the hospital to provide a list of medications to take home, the doses, the frequency, and any specific instructions like taking with food or without food.

Ask why each medication is prescribed. Write down the answers. Is it a new medication started for the hospitalization? Is it a dose change? Is it to replace a home medication? Understanding the reason helps your elder remember to take it.

Ask which home medications were stopped and why. Was it a temporary stop during the hospitalization? Should it be restarted at home? When?

Ask about side effects and what to watch for. What should your elder do if a side effect develops? Should they call the doctor or stop the medication?

Get written instructions. Don't rely on verbal explanations you might forget. Request written materials about each medication.

Before leaving the hospital, make sure you understand. If anything is unclear, ask again. If you're not confident you understand, ask for the hospital pharmacist to explain.

Take the list to your elder's primary care doctor immediately after discharge. Call the doctor's office and ask for an appointment within days of discharge. Bring the hospital discharge papers and medication list.

During this appointment, show the doctor the new medications. Ask about each one. Ask about the ones that were stopped. Ask whether any adjustments are needed. Sometimes the hospital's recommendations are perfect. Sometimes the primary doctor makes small adjustments based on your elder's full health picture.

Ask about interactions between new and existing medications. Even if your elder's original medications weren't changed, they might interact with new hospital medications in ways that need management.

Have your pharmacist review the new medication list too. Pharmacists are medication experts. They might catch something the doctor missed. They can answer detailed questions about how to take medications.

For a few weeks after discharge, watch your elder carefully for new symptoms or problems. Some of these might be from new medications. Some might be from stopping old medications. Some might be from medication interactions. If something seems wrong, contact the doctor.

Make a medication list that includes everything your elder is taking. Include doses, frequency, and any special instructions. Keep this list updated. Bring it to all medical appointments.

Set up a system to help your elder take medications correctly. This might be a pill organizer filled weekly. This might be phone reminders. This might be enlisting family to supervise. For someone confused about medications, supervision is important.

Ask the pharmacist about once-daily formulations if your elder is struggling with multiple daily doses. Sometimes a longer-acting medication once daily is available instead of regular medication multiple times daily. This improves adherence.

Make sure your elder has refills available. Sometimes discharged medications have limited refills and run out before the doctor provides more. Call ahead to ensure prescriptions are refillable.

Some medication changes after discharge are intentional and necessary. Some are oversights. Some are poor communication. The goal is ensuring that whatever medications your elder needs are known, understood, and correctly used.

The first few weeks after hospital discharge are particularly important for medication management. Your elder is recovering from illness. They might be tired or confused. This is when clear medication instructions and support matter most.

If your elder was hospitalized for a serious condition, follow-up with the hospital doctor who admitted them is also important. They might have recommendations about medications or monitoring. They should receive the discharge summary including medication changes. If they don't, send it to them.

Your vigilance during this transition protects your elder from dangerous medication errors. It ensures they get the benefit of hospitalization without the danger of medication confusion.

Before discharge, get a complete written list of medications with doses and frequency. Ask about each new medication and why it's prescribed. Ask about medications that were stopped. Meet with your elder's primary doctor within days of discharge to review medications. Set up a system to help your elder remember to take medications correctly. Watch for problems in the weeks after discharge.