Last week we wrote here on the AgingOptions blog about the importance of preparing for your discharge from the hospital from the moment you arrive. Today we’re considering an important aspect of that preparation. When you’re in the hospital and the time for discharge approaches, there’s a rush of last-minute activity, gathering personal effects and signing discharge papers. Then accompanied by spouse, family or friends, you head for the car and the welcome ride home. As you sigh with relief, there comes a nagging question to your mind: is it possible you forgot anything? According to this article from NextAvenue, it’s entirely likely that the answer is yes – and the consequences could be devastating.
Before Being Discharged, It’s Vital that You Review All Medications Carefully
The article, written by Dr. Jeffrey Schnipper of Harvard, spotlights a 70-year-old New York woman admitted to the hospital for surgery. This woman had multiple medical conditions and was taking 13 medications, all of which were duly reported on admission. However, the article says, when she was discharged, the hospital had prescribed an opioid narcotic for pain – even though she was already on another opioid for a different condition. “Just as troubling,” Dr. Schnipper writes, “no antibiotic was prescribed, even though she had been on one in the hospital. [The patient] then developed a serious infection at the wound site, which led to a complicated recovery.” What was the critically important step this woman and her family had innocently overlooked in the rush of hospital discharge? She and her medical team had not carefully and thoroughly reviewed her medication orders.
This oversight, says Next Avenue, is far from unusual. “For example, one study in cardiac patients found that over half of them had a clinically important medication error within 30 days of discharge from the hospital.” Nonetheless, as important as it is to review medication orders on discharge (and also at other times, as we’ll see below), “in the press of time, other paperwork and transportation worries, many patients and family caregivers don’t focus on the details until they get home.” According to Dr. Schnipper, patients and families often leave this important detail to the hospital, assuming it’s their responsibility. But “patients and caregivers have vital information that only they can provide,” so their role is critically important.
“Med Rec” – Medication Reconciliation – is Vital Before Being Discharged
According to the NextAvenue article, patients tend to believe – mistakenly – that “all of their medications are ‘in the system,’ even though information comes from many sources and is often incomplete or contradictory.” That what makes the process known as “medication reconciliation,” sometimes referred to by doctors and nurses as “med rec,” so important. Med rec, says Dr. Schnipper, “is the process of comparing medications reported on admission to those ordered at discharge to ensure accuracy. It involves many steps and different professionals. It’s something like reconciling a checkbook: Withdrawals should be balanced by deposits, and neither should omit or duplicate items.” He says that, while hospitals across the U.S. are trying to prevent medication errors through better collaboration and communication with patients and families, much more needs to be done to improve the med rec process.
Because hospitalizations are often unplanned, the article suggests it’s a good idea keep an up-to-date medication list with you in case of an emergency. “Be sure to include all prescription drugs with dosages, timing, method of administration (oral, injection, inhaler) and any other instructions,” Dr. Schnipper advises. “All over-the-counter products (vitamins, supplements, herbals) should also be included, because some ingredients may react with newly prescribed drugs.” The article lists some online sources where you can find free medication forms, including a Canadian site called MyMedRec; a site offered by AARP called My Personal Medication Record; and a form from the United Hospital Fund (downloadable in several languages) called the Medication Management Form. Whatever form or record you use, keep it thorough and up-to-date, since medications and supplements change. And keep it handy.
Medication Reconciliation Needs to Happen at Other Times Besides Discharge
We wrote at the beginning of this article about the need for medication reconciliation when you leave the hospital, but that’s by no means the only time this process should take place – and if the hospital staff doesn’t offer it, patients and families may have to be insistent. “There are four times when medication reconciliation is most important,” writes Dr. Schnipper: “before hospitalization or at admission; during the hospital stay; the day of discharge and follow-up after discharge.”
- Upon Admission. Making certain the doctors and nurses in the hospital know exactly what you’re taking, and when and why. This reconciliation should alert them to be on guard for any adverse interactions with drugs you may be prescribed during your stay.
- While You’re There. During the hospital stay, says the article, “Keep track of all medication changes,” and if at any time you don’t understand “why a particular drug is being tried or discontinued or why you need it, ask more questions.” Make sure the hospital staff involves you in their discussions about medications, and if they don’t, you should insist on being included. Ask if new drugs will be covered by your insurance plan.
- On the Day You’re Discharged. “No matter how rushed the discharge, make sure you go over the medication list with a staff member.” Look for changes that have been made and ask why. Ask what to watch out for (such as common side effects) once you’re home, and have a trusted caregiver with you to listen and take notes. “Look out for the most common discrepancies,” says the article: “duplication of medications; omissions of drugs that should be on the list; unexpected changes in dosages or how often to take medications and drugs for which you have an allergy or a known side effect.” Make sure you know whom to call if you have questions once back home.
- After Discharge. “Send a copy of the updated medication list to your primary care physician and any specialists you see regularly. Make sure anyone who helps you follow your medication schedule — family member or aide — understands the new regimen. When filling a new prescription, ask the pharmacist about any special concerns.”
Take an Active Role in Your Health – and in Your Retirement Planning
Here at AgingOptions, we believe that one of the most important steps you can take to protect your health is to find a doctor who really understand the physiology and psychology of aging – and that means finding a geriatrician. These board-certified men and women will take the time to get to know you, and they’ll take a hard, professional look at your entire health regimen including prescription drugs. They’ll also help you prepare for hospitalization and serve as your health care advocate. Please take the time to call us and let us refer you to a geriatrician near you.
Just as medical care requires a thorough and comprehensive strategy, so does retirement planning. Good medical care is important. So is a sound financial plan. But don’t stop there: what about your housing plans? Is your family on board with y0ur retirement wishes? Have you taken the right legal steps to protect your estate? There’s one retirement planning strategy that weaves all these “threads” together – health, finance, housing, family and legal – into a personally designed “retirement tapestry.” It’s called a LifePlan, and only AgingOptions offers it. We hope you’ll join Rajiv Nagaich for a free LifePlanning Seminar where you’ll get your questions answered about this retirement planning breakthrough. For a calendar of currently scheduled seminars, visit our Live Events page. We’ll see you soon – and meanwhile, age on!
(originally reported at www.nextavenue.org)