Hospital discharge with new medication: what to do in the first days
Coming home from hospital with changes to medication is one of the times when mistakes are most likely: a few well ordered steps in the first days make all the difference.
In short
- Hospital discharge is a critical moment: according to Spanish studies, up to 63% of people may have a medication reconciliation error at discharge.
- Before leaving, ask for the discharge medication sheet, the report explaining the changes and any prescriptions needed.
- At home, compare the new regimen with the medicines already in the house and set aside any that have been stopped.
- Spain’s Ministry of Health recommends that the GP reconciles the medication, preferably within the first week after discharge.
The most important thing after a hospital discharge with new medication is being clear about what to take, what has changed and what has been stopped, and having the GP review the treatment in the first few days. Many mistakes happen because old and new medicines get mixed up at home.
This practical guide helps you organise those first days, whether you are the one leaving hospital or you care for a relative.
| What will you find in this article? |
Why are the first days after discharge so delicate?
Because information about medication can be lost or misunderstood on the way from hospital to home. The WHO notes that medication discrepancies affect nearly everyone moving between care settings, which is why it treats transitions of care as a safety priority.
In Spain, studies gathered by the Ministry of Health show that up to 63% of people may have a reconciliation error at discharge, and that the risk rises with the number of medicines and long term conditions. Typical errors are duplicates, omissions, doses different from those prescribed or restarting at home a medicine that had been stopped.
What should you ask for before leaving hospital?
Before leaving, make sure you have in writing the complete medication list and the changes compared with what was taken before admission. The Ministry of Health recommendations state that the hospital should provide a discharge report setting out the changes in treatment, a medication sheet and prescriptions, and explain them to the person and their family or carers.
| What to ask for | What to check |
|---|---|
| Discharge report | That it has a medication section explaining the changes |
| Discharge medication sheet | Name, dose, timing and duration of each medicine |
| Stopped medicines | Which ones are no longer taken and from when |
| Prescriptions for new treatments | That they are available on the electronic prescription |
| Warning signs | Which symptoms mean you should seek advice, and from whom |
If anything is unclear, ask before you go. It is not a nuisance: the Ministry’s own guidance stresses that nobody should leave a consultation with doubts about their medication.
What should you do on the first day at home?
On the first day it is worth physically checking every medicine in the house against the discharge sheet. This is the step that prevents the most mistakes.
- Take out all the packs: those from before the admission and the new ones.
- Mark on the discharge sheet which medicines stay the same, which change dose and which are new.
- Put stopped medicines in a separate bag so nobody takes them by mistake, and ask the pharmacy how to dispose of them.
- Check whether any new medicine is another brand name for one already being taken.
- Organise doses by day and time, using a pill organiser or a personalised dosage system.
- Update the single medication list and share it with anyone who helps with care.
If a new symptom appears, such as dizziness, drowsiness or confusion, speak to the doctor or pharmacist before changing anything yourself. Our list of questions for your doctor may help.
When should you see the GP?
As soon as possible. Spain’s Ministry of Health recommends that the responsible doctor at the health centre reconciles the medication after discharge, preferably within the first week or, in any case, before issuing a prescription for a new medicine.
Reconciling means comparing the medication taken before admission with that prescribed at discharge, spotting the differences and resolving them. This prevents, for example, old prescriptions that the hospital had stopped from continuing to be dispensed. Take the discharge report, the medication sheet and, if possible, all the packs to the appointment. The pharmacy can also help you spot duplicates and adjust how the medication is prepared to the new regimen.
A practical example: José comes home after a hospital stay
Take the case of José, 85, who comes home after ten days in hospital. His diuretic dose has been changed, a new heart medicine has been added and a sleeping tablet has been stopped. His daughter Marta finds at home the old diuretic box, the new one and a pill organiser filled before the admission.
The sensible thing would be to empty that old organiser, refill it using only the discharge sheet, keep the stopped sleeping tablet aside and book a GP appointment in the first few days. Marta should also tell the pharmacy about the changes so the medication is prepared with the new regimen and not the old one.
How can IMA Health help you?
After a discharge, having the medication already prepared with the updated regimen avoids mixing old and new treatments. With IMA Health, a specialised pharmacy prepares the medication by the day and time of each dose, and IMA coordinates changes with the pharmacy, handles home delivery and provides personalised follow-up. To compare alternatives, see our guide to systems for organising medication at home.
Sources
- Spanish Ministry of Health: safe practice recommendations for medication reconciliation at hospital discharge (2019, in Spanish)
- Spanish Ministry of Health: recommendations on medication reconciliation in primary care for people with chronic conditions (2022, in Spanish)
- WHO: Medication Safety in Transitions of Care (2019)
This article is for information only and does not replace advice from your doctor or pharmacist.