Leaving the hospital can be a dangerous time for patients

Why? Changes in care settings, care providers and medications experienced after discharge can result in errors that lead to health care complications. Many people end up going back to the hospital because of these complications, or because they were not prepared to manage their own care.

• Unclear discharge instructions


• Conflicting instructions from different providers


• Medication errors, including dangerous drug interactions, duplications

Don’t make these assumptions

“My primary care doctor knows that I was in the hospital”

It is comforting to think that your primary doctor is communicating with your care team while you are in the hospital. The reality is that your doctor may not know that you were hospitalized.

“My doctor knows what new medications I was prescribed in the hospital”
“The hospital knows what medications I was already taking”

In many cases, the computers in your doctor’s office are not connected to the computers in the hospital.

What can I do to make the transition go smoothly?

As a patient or family caregiver, there are several steps you can take to help you be a more informed and effective member of the care team during the transition back home after hospitalization. By knowing what to expect, you may be able to avoid health care complications and even re-hospitalization.
This discharge checklist was designed to help patients and family caregivers know what questions to ask prior to discharge. The goal of this tool is not to complete or check off each box, but rather to encourage you to speak up about your anticipated needs. There are four steps you can take (called the “Four Pillars”) to help you prepare for and anticipate next steps in managing your healthcare.

1)Medication Management: During hospitalization, you or your loved one may have been prescribed new medications. It is important that you talk to your doctor or pharmacist about these changes. They will need to know what medications you were taking prior to your hospitalization, and see what new medications were prescribed during discharge. It is important that you tell them exactly what you are taking and how. If there are medicines that you have been prescribed but are not taking, you should let your doctor know that too.

Tips for Effective Medication Management:

• Identify a single community pharmacist or pharmacy – Working with a single pharmacy where you take all of your prescriptions to be filled greatly reduces the chance for medication errors. Your pharmacist will be able to identify possibly dangerous drug interactions, duplication (multiple prescriptions that do the same thing), and advise you on the appropriate use of over-the-counter medications.
• Understand your medications – You should know why you are taking each medication, when and how to take it, and the possible side effects. If you are not sure about a particular medication, ask your doctor or pharmacist.



• Keep an updated medication list – This list should be a record of exactly how you are taking your medications. Take this list with you to every medical appointment and show it to your doctor or specialist. After being discharged from the hospital, compare your medication list to the medications listed on your discharge paperwork.
• Medication System – Develop an effective system to help you organize your medications and take them as prescribed. Weekly pill organizers are one way.
How to refill a weekly pill box

Useful tips for managing medication

2) Red Flags: It is also important that you understand the health conditions that you or your loved one has and how to recognize “red flags” or warning signs that may indicate a condition is worsening. You may want to use a Personal Health Record to list health conditions, red flags, and what action steps you will take when you identify a problem (see #4 below).

Tips for Recognizing and Responding to Red Flags

• Know what to watch for – Do you know what the warning signs are that your health condition(s) are getting worse? If not, talk to your doctor about what to watch for. Identify 3-5 red flags to monitor.
• Know what to do – Develop an action plan that you will follow when warning signs appear. You should ask your doctor’s office to explain what types of afterhours care is available. In some cases, your action plan might include calling the doctor, while in others you might need to visit an urgent care center [Urgent Care Guide]. You should also know when it is necessary to seek treatment in an emergency department.

3) Follow-up with Primary Care doctor: You should see your doctor within one week after being discharged from the hospital.

Tips for Follow-up Care after Discharge:

• Call soon – Make your follow-up appointment in the first days following discharge to ensure that you are seen within a week. When making the appointment, mention the recent hospitalization, be specific about how soon you want to be seen, and mention any questions you need to have answered, such as changes to medications.
• Prepare questions for your appointment – Bring a list of 2-3 questions to ask the doctor at your follow-up appointment.

4) Bring all of your medications to the appointment— Including vitamins, supplements, and over-the-counter medications.

5 Use a Personal Health Record Click to download

Many patients and family caregivers have found this booklet helpful in organizing important health information including medications, health conditions, and questions for your doctor. Keep this tool updated and take it with you to every medical appointment. To print your own Personal Health Record, select double-sided printing, then fold the booklet in the middle.

More tips and tools

Next Step in Care Tools for Family Caregivers (^® United Hospital Fund)

A campaign of the United Hospital Fund, NextStepInCare has a wealth of information and resources available on topics such as urgent care centers, HIPAA, medication management, discharge planning and home care http://www.nextstepincare.org/Caregiver_Home/

• What Do I Need as a Family Caregiver? ^®2008 United Hospital Fund) A checklist to help family caregivers plan for services that they or their loved one might need after discharge.
• Emergency Room (ER) Visits: A Family Caregiver’s Guide (^®2010 United Hospital Fund) A tool for family caregivers to help them plan ahead to manage medical emergencies.
• HIPAA: Questions & Answers for Family Caregivers (©2010 United Hospital Fund) A guide explaining HIPAA (Health Insurance Portability and Accountability Act) – the federal law that protects personal medical information and recognizes the rights to relevant medical information of family caregivers and others directly involved in providing or paying for care.

Publications

New York Times author Judith Graham wrote “More on Preventing Hospital Readimissions” in her online blog The New Old Age, Caring and Coping.

Author Barb Warner has a new book out called “Keep Your Fork Dessert is on The Way: Savoring the Second Half of Life”. To order Barb’s book or learn about her “Powerful Tools for the Second Half of Life” click here.

The Care Transitions Intervention^® and all of its materials are the property of the Care Transitions Program^®. The Care Transitions Program^® is solely authorized to provide training on the Care Transitions Intervention^®. If another entity offers to train your organization, please contact us.

© Eric A. Coleman, MD, MPH