Medications at discharge aren't just for the long haul: A model for the management of short-term medications

Abstract

Unsuccessful medication management (MM) after hospital discharge contributes to suboptimal outcomes including readmissions, emergency department visits, and death. Prior models and toolkits for MM at the hospital-to-home transition such as the Agency for Healthcare Research and Quality Medications at Transitions and Clinical Handoffs (MATCH) Toolkit for Medication Reconciliation focus on the patient and healthcare workers and not on other factors that may impact MM. While the Transition Model of MM describes the hospital-to-home transition of MM tasks among older adults with a particular focus on the MM work system, it focuses on initiation or continuation of chronic medications. However, many medications in classes responsible for the greatest number of readmissions are not intended to be taken chronically. Examples include antibiotics, opioids, and steroids, which are often prescribed for short durations; and diuretics, hypoglycemics, and vitamin K antagonists, which require careful titration. Short-term MMmay require changes to standard MMmodels, as shortterm medications need to be started immediately on discharge, and stopped or adjusted within just a few days or weeks after discharge. We will describe the current state of short-term MM at the hospital-to-home transition and hazards to short-term MM (Figure 1), and suggest how to address these hazards. The work systems of the hospital and the home intertwine in short-term MM at the hospital-to-home transition. The hospital work system and home work system interact with ambulatory pharmacies and clinics and each other. We will describe each work system, necessary processes in each work system for short-term MM, and associated hazards.