Which medications should you take when you come home from the hospital?

Patients understanding of which medications to use just after hospital discharge is poor.¹ Medications that patients take at home before being admitted to the hospital are often re-dosed or stopped, with very little understanding by patients regarding these changes.² Though a list of medications with doses, schedule, purpose, and comparison with preadmission medications have become a standard part of discharge instructions³, studies show that patients still display limited knowledge about discharge medications. In a study of 172 recently hospitalized patients called within the first three weeks after discharge, only 64% of patients could identify the name of any new medications they were prescribed in the hospital, and only 56% could identify the dosages.⁴ Another study of heart failure patients found that only 18% of hospitalized patients knew the correct number of medications they were prescribed at three months after hospitalization.⁵

Medication discrepancies upon care transitions can lead to patient harm. One randomized trial of 851 patients discharged from two large academic hospitals found that within 30 days after discharge, 432 (50.8%) had one or more clinically important medication errors; 23% of such errors were judged to be serious and 2% life-threatening.⁶ Other studies report that adverse drug events occur in 11-17% of patients within the first few weeks after discharge.^7-9 To prevent medication discrepancies upon discharge, it is important to encourage patients to adhere to their discharge medication list, and follow up with their doctor as soon as they can if they are confused about which medications to take.

^References

1. Makaryus AN, Friedman EA. Patients' understanding of their treatment plans and diagnosis at discharge. Mayo Clin Proc. 2005;80(8):991-4.
2. Ziaeian B, Araujo KL, Van Ness PH, Horwitz LI. Medication reconciliation accuracy and patient understanding of intended medication changes on hospital discharge. J Gen Intern Med. 2012;27(11):1513-20.
3. Halasyamani L, Kripalani S, Coleman E, Schnipper J, van Walraven C, Nagamine J, et al. Transition of care for hospitalized elderly patients--development of a discharge checklist for hospitalists. J Hosp Med. 2006;1(6):354-60.
4. Maniaci MJ, Heckman MG, Dawson NL. Functional health literacy and understanding of medications at discharge. Mayo Clin Proc. 2008;83(5):554-8.
5. Custodis F, Rohlehr F, Wachter A, Bohm M, Schulz M, Laufs U. Medication knowledge of patients hospitalized for heart failure at admission and after discharge. Patient Prefer Adherence. 2016;10:2333-9.
6. Kripalani S, Roumie CL, Dalal AK, Cawthon C, Businger A, Eden SK, et al. Effect of a pharmacist intervention on clinically important medication errors after hospital discharge: a randomized trial. Ann Intern Med. 2012;157(1):1-10.
7. Forster AJ, Murff HJ, Peterson JF, Gandhi TK, Bates DW. The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med. 2003;138(3):161-7.
8. Forster AJ, Clark HD, Menard A, Dupuis N, Chernish R, Chandok N, et al. Adverse events among medical patients after discharge from hospital. Cmaj. 2004;170(3):345-9.
9. Forster AJ, Murff HJ, Peterson JF, Gandhi TK, Bates DW. Adverse drug events occurring following hospital discharge. J Gen Intern Med. 2005;20(4):317-23.