Dose, route and frequency
Q. May the discharge list contain only the names of the medications or must it also include doses, routes, frequencies, etc?
A. Taken literally, the medication lists required by National Patient Safety Goal 8 need only contain the name of the drugs. However, when the lists are seen as resources supporting the required processes of reconciliation, communication, and patient/client/resident education about medication use, it becomes clear that more than just the drug name is required. Standard PC.02.03.01 requires the organization to educate patients/clients/residents about the safe and effective use of medications. Standard PC.04.01.05 requires that the discharge instructions be provided in an understandable manner. Therefore, in order to serve as an adequate basis for these discharge instructions and the required patient/client/resident education, information about the dose, route, frequency, duration of therapy, indications for the drug, and other relevant information must be available. The discharge list of medications required by NPSG.08.03.01 is an excellent place to have this information.
Discharge list
Q. What goes on the discharge list of medications? Should it list everything that the patient was given while in the hospital?
A. The discharge medication list should include all the medications (prescription, OTC, herbals, etc) that the patient/client/resident should be taking following discharge. It should not include medications that were given only during that episode of care if those medications are not to be continued after discharge. The discharge medication list is not an “order” for medications; it is just a summary list of everything the patient/client/resident will be taking—similar to the home medication list that was gathered at the time of admission. It should be treated in the same way as other discharge instructions (PC.04.01.05) and used for providing patient/client/resident education about the safe and effective use of medications (PC.02.03.01).
The discharging physician is not expected to order or reorder any medications that the patient/client/resident was already taking prior to admission. The discharge medication list is not a doctor’s order. It is simply a list of all medications that the patient/client/resident will be on following discharge. Any discharge instructions, including the list of medications, must be in writing (required by standard PC.04.01.05).
Resume orders (blanket reinstatement)
Q. If the discharging physician doesn’t have to reorder the patient’s home medications, can we just instruct the patient to “resume previous home medications?” Isn’t this a violation of the standards?
A. Three related terms are relevant to this discussion: discharge orders; discharge instructions; and the discharge list of the patient/client/resident’s medications, as required by Goal 8. They are all different and have different purposes. Discharge instructions are not orders. Nor is the complete list of the patient/client/resident’s medications at discharge an order. While the discharging physician doesn’t have to re-order patients’ OTCs or herbals that they were taking pre-admission, those OTCs and herbals must be on the list of medications that the patient/client/resident will be taking post-discharge if the patient/client/resident intends to continue them and there are no contraindications.
Discharge instructions are directed to the patient. Discharge orders are directed to other caregivers. The requirement in the Medication Management standards that prohibits blanket reinstatement orders applies to medication orders, not to discharge instructions. Although the standards are silent on the subject of blanket reinstatement instructions, this is not considered acceptable practice and is inconsistent with standard PC.02.03.01, which requires the organization to educate patients on the safe and effective use of medications.
Discharge summary as patient instructions
Q. Can the discharge list of medications be part of the discharge summary or must it be a separate document?
A. It is acceptable to use the discharge summary as the vehicle for communication of this information to the next provider of care as long as it is available to the next provider when it is needed; for example, when the patient is seen next by that provider. However, the discharge summary would not necessarily be a useful form for providing the discharge list of medications to the patient. For that purpose, providing the list as a separate document or as part of the discharge instructions would be more useful to the patient.
Abbreviations in list
Q. Must the list of reconciled medications provided to the patient be written out in a format with complete English language frequency instructions, or are standardized and approved medical abbreviations such as BID or TID acceptable?
A. The discharge list of medications is a part of the discharge instructions, which must be provided to the patient/client/resident in writing and in a form that the patient/client/resident can understand (standard PC.04.01.05). The list also provides a basis for the required patient/client/resident education (PC.02.03.01) about the safe and effective use of medications.