A complicated discharge list

Setting: Hospital discharge pharmacy

Joan Mills, 76, is preparing for discharge after admission. Her signed discharge medicine list includes continued, changed and stopped items; she has not yet compared it with the boxes at home and cannot comfortably read its small print.

Task

Explore small-print difficulty and home medicine stock.
Reconcile boxes against the signed discharge list.
Clarify discrepancies before final instructions.
Provide large print and check the continued, changed and stopped plan in the patient’s own words.

A complicated discharge list consultation plan

The signed discharge list is the current reference for this consultation.
The pharmacist will compare each home medicine against that list and mark continued, changed and stopped items.
Any discrepancy must be clarified with the discharge prescriber before instructions are finalised.
A large-print list and a teach-back check are available; no unsupplied dose changes should be invented.
Joan Mills, 76, is preparing for discharge after admission. Her signed discharge medicine list includes continued, changed and stopped items; she has not yet compared it with the boxes at home and cannot comfortably read its small print.

Fictional scenario information supplied for this examination exercise; not medical guidance for real patients.