Ask Your Pharmacist

August 12, 2020

My husband had a recent hospital admission. He was in the hospital for a week and by the end of his stay, many of his medications had changed. What advice do you have for someone being discharged from hospital about how to manage their medication changes?


During a hospital stay, your medication therapy can undergo several changes compared to how you were taking them prior to hospitalization. If these changes are not communicated at hospital discharge, they can lead to medication errors. A Canadian study found that nearly one in four patients had a preventable unwanted reaction (harm caused by a drug or the inappropriate use of a drug) in the 30-day period after hospital discharge. According to the Institute for Safe Medication Practices in Canada, a study looking at medication lists for geriatric patients at the time of discharge from hospital showed that over half of patients experienced at least one medication error related to differences between medications taken prior to admission and discharge prescriptions. 

What can you as a patient do?

Often, once you hear it is time to be discharged home from hospital, you are so excited and relieved, you just want to go home, and you forget to ask important questions about changes to your medications that you will need to know for after discharge. Most hospitals in New Brunswick now use a Best Possible Medication Discharge Plan form to help communicate medication therapy changes to you.

It is a really good idea to have this form, along with your discharge prescriptions, reviewed with you by a pharmacist prior to hospital discharge. If a pharmacist is not available on your particular ward, ask for this review to be done by a registered nurse, physician, or other appropriate health care professional. Compare the medications you were on at home prior to hospital admission with your discharge prescriptions. Do you notice any differences in your medication therapy that were not explained? Are any medications discontinued? Are the dosages the same as before your hospital stay? Are there any new medications? What is the reason for the new medication? Are there side effects to any new medications and what do you do if you experience them? How long are you meant to be on the new medications? There can be several changes to how you take your medicine at hospital discharge compared to how you took them when you were admitted to hospital. 

Ideally, ask that your discharge prescriptions be faxed to your community pharmacy prior to you being discharged from the hospital. This is an excellent way to have changes to your medication therapy communicated. Advanced notice gives your community pharmacist time to review your medication profile to make sure that your medications are safe, effective, and that any drug-drug interactions are dealt with. It allows time to resolve issues of drug coverage prior to you arriving to pick up your prescriptions. In this day of multiple drug shortages, it is important to give your pharmacy time to get a supply of medication that you need at discharge and to come up with alternative therapy should your drug not be available. When you arrive at your pharmacy to pick up your filled prescriptions, take the time again to review your home medications with your pharmacist. If possible, bring a loved one or caregiver to hear the pharmacist’s instructions. You can often get information overload at hospital discharge, and a second set of ears may prove helpful.

We are fortunate as Canadians to have a publicly-funded and world-class health care system.  Our duty as citizens in this system is to understand that ultimately our health is our responsibility. One way you can demonstrate personal responsibility for your health is to make sure that you clearly understand medication discharge instructions. How do you do this? Ask as many questions as needed until you are confident and comfortable with the instructions you have been given. Remember, when it comes to your medication therapy you can never ask too many questions. A pharmacist is always happy to answer these questions for you.

Dr Kevin Duplisea (PharmD BSc. Pharm, BSc. ACPR) is a pharmacist at Sharp’s Corner Drugstore in Sussex, New Brunswick. His opinions expressed in this newspaper are published for educational and informational purposes only, and are not intended as a diagnosis, treatment or as a substitute for professional medical advice, diagnosis or treatment. Send your questions to