Dealing with Discharge Medications

Ten Suggestions for Discharge Medications: Make Going Home Safer and Easier

Written by: Jennifer Gunter MD, FRCS(C), FACOG, DABPM

Over 75 percent of children with special needs will be admitted to the hospital within the first five years of life. With an average of four admissions during these early years, many children are likely to be prescribed one or more medications when they are discharged home. The dose of a current medication may be changed or a new medication could be added such as a short-term prescription, like an antibiotic for pneumonia or a long-term medication for chronic conditions such as asthma or epilepsy. In the rush to go home, prescriptions are often treated as an afterthought and “just pick them up on the way out” is a common refrain.

Unfortunately up to 70 percent of children taking long-term medications and 20 to 40 percent of children taking short-term medications are not taking them as directed. For many of these children, issues at the time of hospital discharge, such as confusing instructions, medication errors, and insurance issues are contributing factors.

Medication adherence, taking medications exactly as prescribed, is hard for everyone; even one-third of doctors do not take their own prescriptions correctly. For parents of children with special needs, a variety of factors may be involved including cost, complicated instructions, the number of doses a day, and concerns over side effects. In addition, some children have sensory integration problems with increased awareness to new tastes and textures. Parental forgetfulness may also occasionally be a factor as many children take several medications and have involved medical needs that can be overwhelming at times. To prevent medication errors and improve adherence, the Institute of Medicine recommends that parents take an active role in reviewing prescriptions for their children prior to discharge. Here are ten ideas to help parents of a child who has special needs navigate the process of receiving discharge medications to make the transition home safer and easier.

  1. Ask if a generic medication is available; you will always have a lower co-payment.
  2. If the prescription calls for more than one dose a day, ask if there is an alternative that can be given once a day or at least less often. Reducing the number of times a day that a medication is required will be easier for both you and your child and decreases the chance of missed doses.
  3. Have prescriptions sent to the discharge pharmacy the day before discharge. If there are insurance issues, you want enough time to complete an appeal or discuss an alternative medication with the medical team.
  4. Ask for written information about each medication, including dose, how often it is to be taken, and side effects. Many medication instructions are easily misunderstood so repeat them back to the pharmacist and your doctor before discharge and make additional notes if necessary.
  5. Double check the medication and dose that you picked up from the pharmacy with the medical team to make sure they are correct. Up to 12 percent of discharge prescriptions written by hand and 6 percent of electronic prescriptions contain errors.
  6. Ask to speak with a clinical pharmacist before discharge to review the medications. They can come to your hospital room for your convenience. Ask about potential side effects and interactions with other prescriptions, over the counter medications, and food.
  7. Prepare and administer at least one dose of each new medication yourself prior to discharge so you know exactly how to give the medication when you get home.
  8. Ask what to do in the event you miss a dose. No one plans to forget his or her child’s medication. Having a child with medical problems is at times overwhelming and, therefore, missed doses may happen. Make sure you know if you should give the next dose right away or skip it altogether.
  9. Sign up for mail order prescriptions if offered by your insurance carrier. Ask your physician for a written 90-day prescription for any long-term medication. Send it to the mail order pharmacy, and you will get three months’ worth of medication mailed to your house for one co-payment. You will reduce the number of trips to the pharmacy and save money.
  10. Make sure that you have a follow-up appointment with your child’s physician. Not only should your doctor evaluate your child’s progress since discharge, but you will also need to get refills for long-term medications if mail order is not available.

 

Dr. Jennifer Gunter is the parent of twins with special needs and a physician who has been practicing medicine for over 15 years. She believes in patient and parent advocacy and runs the Web site www.thepreemielife.com for families living with prematurity.