After a long hospitalization, it is discharge day for your patient.

And you are taking your patient and their carer through the changes in their medication.

This can be a confusing time for patients.

They are being told that what they had been taking has now been changed.

Nearly 70% of patients were found NOT to be taking their prescribed medication.

As well only one quarter knew the reasons they were taking the medication.

It is a very difficult situation as patients may not know whether to continue with their home medication, change to their hospital medications, or if to make adjustments.

It is not surprising that those patients taking the highest number of medications were least like to continue with the new medication.

So you would think that you would want to keep discharge medication teaching simple.

The American Journal of Nursing has “thoughtfully” provided an eighteen step process for a teaching plan to take patients and carers through new discharge medication.

With no obvious sense of irony, the writers said “ that the key to successful teaching was to keep it as simple as possible.”

The advice provided is good.

It is that the authors needed to take their own advice about keeping it simple.

Here is the teaching plan in full:

    1.     Identify who will be the person assisting with medication management at home. This may not be the person who has been at the bedside.

    2.    Coordinate a time for teaching and return demonstration prior to discharge. 

    3.    Identify the goals of care with the family caregiver and patient. 

    4.    Provide a verbal and written explanation of why each medication is prescribed, how it works, and how long it needs to be taken. 

    5.    Describe how the patient and family caregiver will know if the medication is effective and ensure they also have this information in writing. 

    6.    Articulate, both verbally and in writing, potential interactions with other medications. These may include prescription and nonprescription medications as well as herbal or homeopathic preparations. 

    7.    Discuss and write down special considerations, such as whether the medication needs to be taken with or without food, by itself (for example, thyroid supplementation), or with other medications (for example, iron and vitamin C). 

    8.    Discuss and provide written instructions regarding whether the medication can be chewed, crushed, or dissolved. 

    9.    Identify special considerations, such as swallowing concerns, in conversation and in writing. Determine whether a swallowing study has been completed or is needed. 

    10.    Describe, both verbally and in writing, the common adverse effects of a medication and when and whom to call should they occur. 

    11.    Write instructions clearly. If handwritten, use print rather than cursive writing. If using a computer, choose a sans serif, larger-size font. Ensure these instructions are appropriate for the patient and family caregiver’s literacy level. 

    12.    Identify whether the family caregiver has access to transportation to the pharmacy. In addition, ask if the caregiver’s work schedule allows her or him to pick up medications at the pharmacy during regular business hours. 

    13.    Ascertain whether special pharmacy services are needed, such as home delivery, online refills, or medication review and counseling. (sic)

    14.Inquire if the family caregiver has concerns about being able to manage the medication regimen, or if she or he anticipates any potential problems. 

    15.    In conversation with the family caregiver, brain- storm and troubleshoot how to avoid potential medication problems, writing down suggestions. Make sure the family caregiver knows who to call (such as the provider, pharmacist, or telephone tri- age nurse) if the treatment regimen needs to be adjusted or if a mistake occurs, such as a missed dose. 

    16.    Stress the importance of coordinating with the patient’s provider before making any changes to the medication regimen. 

    17.    Help the family caregiver to identify potential re- sources, such as the Food and Drug Administration’s Web site (www.fda.gov) and medication instruction materials. The latter may include medication guides provided at the time of discharge, medication package inserts, and patient information provided by the pharmacist. 

    18.    Confirm that the family caregiver understands your instructions by asking her or him to repeat information you’ve provided, for example, about medication doses and administration times. 

To learn more about discharge and medication :

Pasina, L., et al. “Medication non-adherence among elderly patients newly discharged and receiving polypharmacy.” Drugs & Aging 31.4 (2014): 283.

Sexson, Kathryn, Allison Lindauer, and Theresa A. Harvath. “Discharge Planning and Teaching.” AJN The American Journal of Nursing 117.5 (2017): 58-60.

Witticke, D., et al. “Opportunities to reduce medication regimen complexity: A retrospective analysis of 500 patients at discharge from internal medicine of a university hospital.” Drug Saf (2012).