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檢視出院時間軸，並判斷護理師應如何在個案離開醫院前處理藥物不一致的情形。

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Time	Data
0800	Pharmacy-verified home list: insulin glargine 24 units subcutaneously nightly. The client confirms this was the dose used before admission.藥局確認的居家用藥清單：胰島素 glargine 每晚皮下注射 24 單位。個案確認這是入院前使用的劑量。
0900	Inpatient medication record: insulin glargine 12 units nightly while oral intake was reduced.住院給藥紀錄：口服攝取減少期間，胰島素 glargine 每晚 12 單位。
1030	New discharge prescription: insulin glargine 18 units nightly. Draft after-visit summary still lists both 12 units and 24 units as active.新出院處方：胰島素 glargine 每晚 18 單位。出院後摘要草稿仍同時列出 12 單位及 24 單位為使用中。
1100	The client asks, Which dose do I take tonight? Final discharge teaching has not started.個案詢問：「我今晚該打哪個劑量？」最終出院教導尚未開始。

Q1. What does the timeline reveal?時間軸顯示了什麼？

The inpatient dose automatically becomes the discharge dose住院劑量自動成為出院劑量 An unresolved medication discrepancy exists across transition documents轉銜文件中存在未解決的藥物不一致 The client should select the dose that was used longest個案應選擇使用時間最長的劑量

Q2. What should the nurse do before completing discharge teaching?護理師在完成出院教導前應先做什麼？

Teach all three doses and let the client decide at home教導三種劑量，讓個案在家自行決定 Choose the 12-unit dose because it is the lowest選擇 12 單位的劑量，因為它是最低劑量 Clarify the intended regimen with the prescriber and pharmacist and correct all discharge documents與處方者及藥師澄清預期的用藥方案，並更正所有出院文件

Q3. Which finding best shows that medication reconciliation is complete?哪一項發現最能顯示用藥整合已完成？

One consistent regimen appears on the prescription and after-visit summary, and the client explains it correctly by teach-back處方及出院後摘要上呈現一致的用藥方案，且個案能透過回覆示教正確說明 The conflicting lists remain attached so the clinic can review them later保留互相衝突的清單，以便之後由門診檢視 The client signs the discharge form without explaining the regimen個案簽署出院表單，但未說明用藥方案

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