Keeping medicines straight at home after the hospital

In a study of 400 patients sent home from a hospital’s medical service, about 1 in 5 had an adverse event in the weeks after, and two thirds of those events came from medicines.¹ The trip home is when medicine lists get crossed: a new prescription, an old bottle that should have stopped, a dose that changed. This note explains how to get to one correct list, set up a routine that holds, and know when to call.

The short answer

• Get to one list. Compare the discharge medication list with every bottle in the house, and ask about anything that doesn’t match.²
• Keep the list with you, and go over it with every doctor and pharmacist.³
• Use a pill organizer, and take each medicine exactly as prescribed. Don’t skip doses or stop a medicine without asking first.³
• With home health, a nurse reviews every medicine for side effects, interactions, duplicates and missed doses.⁴
• Get rid of stopped and expired medicines through a take-back site, so they can’t slip back into the routine.⁵

Why the trip home is risky

When researchers followed 400 patients after they went home from an academic hospital’s medical service, 76 of them, 19%, had an adverse event, found when they were called about three weeks later. Adverse drug events were the most common kind, about two thirds of the total.¹

Medicines change during a hospital stay for good reasons. Most of the changes are on purpose, but unintended changes happen often, and they can leave out a needed drug, double up a therapy or list the wrong dose.² Reviewing the complete list at every change in care, called medication reconciliation, is how those mistakes get caught.²

Getting to one list

Do this the first day home, or before, if a family member can get to the house first:

• Gather every medicine in the house: prescriptions, over-the-counter medicines and herbal products, plus vitamins, supplements, inhalers, patches, creams and eye drops.³
• Line them up against the discharge medication list.
• Sort them into three groups: on the new list and unchanged, on the new list but changed, and not on the new list at all.
• Ask the doctor, the pharmacist or the home health nurse about everything in the second and third groups. Don’t guess about a medicine that’s missing from the list. It may have been stopped on purpose.
• Write the one correct list: each medicine’s name, the dose, when to take it and what it’s for.

In one picture

Sort them into three groups

1. 1on the new list and unchanged
2. 2on the new list but changed
3. 3not on the new list at all

Ask the doctor, the pharmacist or the home health nurse about everything in the second and third groups

Write the one correct list

Source · medlineplus.gov

Keeping the list working

• Keep a copy at home and one in a wallet or purse.³
• Give every doctor and pharmacist a copy, and go over it at each appointment.³
• Bring it to any hospital stay or emergency visit.³
• Before starting anything new, even an over-the-counter medicine, ask whether it could interact with what the person already takes.³
• Tell the doctor about side effects.³

A routine that holds

• A weekly pill organizer, filled at the same time each week, keeps medicines organized and makes a missed dose easy to see.³
• Tie doses to things that happen every day, like breakfast or bedtime.
• Take each medicine exactly as prescribed. Don’t skip doses, double up or stop a medicine without talking to the doctor first.³
• If one person fills the organizer and another gives the pills, write down who did what and when.

What the home health nurse does

When someone gets home health, the nurse reviews every medicine as part of the first assessment, looking for side effects, drug reactions, medicines that aren’t working, interactions, duplicates and doses not being taken.⁴ The agency also gives the family a written medication schedule with each medicine’s name, dose and timing, and notes which medicines agency staff will give.⁶

Hand the nurse every bottle, including the ones that aren’t on the list. The first home health visit covers what else to have ready.

When to call

Call the doctor, the pharmacist or the home health nurse the same day if:

• A medicine on the discharge list isn’t at the pharmacy, or costs more than the person can pay
• The new list and the bottles don’t match, and nobody has explained why
• Doses were missed or doubled
• The person is newly dizzy, confused, unusually sleepy or unsteady after a medicine change, or has fallen

For a severe reaction, like trouble breathing or swelling of the face or throat, call 911.

Getting rid of old medicines

Stopped and expired medicines are how an old dose sneaks back in. The FDA’s first choice is a drug take-back location, a pharmacy drop-off kiosk or a prepaid mail-back envelope.⁵ Flush a medicine only if it’s on the FDA’s flush list.⁵ If there’s no take-back option, mix the medicine with something unappealing like coffee grounds or cat litter, seal it in a container, put it in the household trash, and scratch out the personal information on the label.⁵

Questions families ask

The hospital list leaves off Mom’s blood pressure pill. Should she keep taking it?

Ask before deciding. A medicine missing from the discharge list may have been stopped on purpose or left off by mistake, and the prescriber or pharmacist can say which.²

Do vitamins and supplements belong on the list?

Yes. The list should include prescription, over-the-counter and herbal products.³

Is a pill organizer worth it?

It can help keep medicines organized, and it makes a missed dose easy to see.³

What does the home health nurse check?

Every medicine, for side effects, reactions, interactions, duplicates, medicines that aren’t working and doses not being taken.⁴

How do we get rid of the old pills?

Use a drug take-back location, a pharmacy kiosk or a mail-back envelope. If none is available, mix the pills with coffee grounds or cat litter, seal them in a container and put them in the trash.⁵

Sources

Sources · 6 references

1. Forster AJ, Murff HJ, Peterson JF, and others, “The incidence and severity of adverse events affecting patients after discharge from the hospital,” Annals of Internal Medicine, 2003; 138(3): 161-7. pubmed.ncbi.nlm.nih.gov (opens in a new tab)
2. Agency for Healthcare Research and Quality, PSNet, “Medication Reconciliation,” patient safety primer, last reviewed 2024. psnet.ahrq.gov (opens in a new tab)
3. MedlinePlus, “Taking multiple medicines safely,” National Library of Medicine, reviewed July 23, 2024. medlineplus.gov (opens in a new tab)
4. 42 CFR 484.55, “Condition of participation: Comprehensive assessment of patients.” Legal Information Institute, Cornell Law School. law.cornell.edu (opens in a new tab)
5. U.S. Food and Drug Administration, “Where and How to Dispose of Unused Medicines,” April 16, 2025. fda.gov (opens in a new tab)
6. 42 CFR 484.60, “Condition of participation: Care planning, coordination of services, and quality of care.” Legal Information Institute, Cornell Law School. law.cornell.edu (opens in a new tab)