Page 64 - Hospitalists - Risks When You're the Doctor in the House (Part One)

SVMIC Hospitalists - Risks When You’re the Doctor in the House

• Having an accurate preadmission medication list

• Having an accurate list of medications being taken by the
patient at the time of discharge

• Having knowledge of what medication changes were

made during hospitalization and the reasons for the
changes

Once an accurate discharge medication list is generated, the
physician should communicate this information effectively to the

patient or and/or caregivers. Older and/or impaired patients do
not always understand the new dosing of medications they were

taking or the reasons for medication changes. A formal process
of medical reconciliation reduces the risk of medical adverse

events and reduces medication discrepancies in addition to
actual and potential adverse drug events. The most effective

interventions involve a patient’s entire medical team.

Discharge Summary

Often the primary mode of communication between the hospital
care team and aftercare providers is the discharge summary.

In order for an aftercare provider to effectively provide care,
the discharge summary must be timely in relation to the actual

discharge of the patient, and be clearly understood by the
patient and other caregivers.

Important elements in the discharge summary as mandated by
the Centers for Medicare and Medicaid Services, are:

• The outcome of the hospitalization;

• The disposition of the patient; and

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