Medicines are frequently changed during a hospital stay — some are stopped, some are started and some doses are altered. Confusion between the old and new lists is one of the most common and preventable causes of problems after discharge.
During a hospital stay, doctors may stop medicines that are no longer suitable, start new ones, and change doses in response to the illness or test results. At home, the patient often still has their previous supply of medicines. Without a careful comparison, it is easy for a stopped medicine to be restarted, for a new medicine to be missed, or for two versions of the same medicine to be taken together.
Older patients, patients taking many medicines, and patients who were confused during their illness are at the greatest risk. Families play an important part in preventing these errors.
On the first day at home, gather every medicine in the house that the patient has been using, including tablets, inhalers, injections, eye drops, creams and supplements. Then compare them with the discharge medicine list. For each item, decide whether it is:
If a medicine the patient was taking before admission is not mentioned on the discharge list, do not assume it was deliberately stopped — it may have been omitted by accident. Ask the hospital team or your doctor to confirm. Do not restart an omitted medicine until its status has been clarified with the treating team, doctor or pharmacist.
Place stopped medicines in a separate, clearly labelled bag, away from the medicines in current use. Do not throw them away until the doctor has confirmed they are no longer needed, but make sure they cannot be picked up by mistake. Ask a pharmacist how to dispose of unwanted medicines safely.
The same medicine is often sold under several brand names, and the name on a hospital prescription may differ from the name on the packet at home. A patient may therefore take a new brand from the hospital and continue an old brand of the same medicine, doubling the dose.
Check the generic (active ingredient) name, which is usually printed on the packaging in smaller type. If two packets share the same active ingredient, ask whether both should be taken. A pharmacist can help with this check.
Errors with some medicines are more likely to cause serious harm. Take particular care with:
For these medicines, make sure you understand the exact dose, timing and duration, and any blood tests or monitoring required.
If a dose is missed, do not automatically double the next dose. The right action depends on the medicine — check the leaflet or ask a pharmacist or doctor.
Report possible side effects to the doctor, such as dizziness, falls, unusual drowsiness, rash, swelling, stomach bleeding (black stools or vomiting blood), unusual bruising or bleeding, or very low blood sugar readings. Some of these need urgent attention; see when to contact a doctor after discharge.
Do not restart an old medicine, stop a new one, or change a dose without advice — even if the patient feels better or worse. If the discharge list is unclear or seems to contain an error, contact the prescribing team, your doctor or a pharmacist before giving the medicine.
A medicine review by a doctor soon after discharge can be valuable, particularly for patients taking many medicines. Bringing all medicines, the discharge summary and any home readings makes the review much more effective — see our guide on what medical records and medicines to keep ready.
Published by: Sineth Hospitals
Medically reviewed by: Dr. Seneth Gajasinghe, MBBS (Colombo), MD (Colombo), Medical Director, Sineth Hospitals
Last reviewed:
Do not stop, start or change a medicine based on this guide alone. If the discharge list is unclear, ask the prescribing team, your doctor or a pharmacist.
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