Medicine as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” An estimated 36% of adults have limited health literacy, which may not be related to years of education or general literacy Low health literacy has been related to medication error, repeat emergency department visits, and morbidity/mortality after discharge When reviewing discharge instructions, the practitioner must be aware of possible health literacy deficits and pay particular attention to cultural considerations affecting understanding of discharge instructions and medication instructions, including dosing The addition of careful verbal instruction review may help to overcome health literacy disparity NONNATIVE ENGLISH-SPEAKING PATIENTS Nonnative English speakers may be at higher risk of failing to understand discharge instructions, especially if adequate interpretation services are not available Use of a professional interpreter has been associated with greater odds of caregiver comprehension and complete discharge education content, including critical aspects such as medication dosing Instructions, when possible, should be provided in the native language of the parent/guardian in written form, or at least reviewed using an interpreter to verbally translate the most critical aspects of the discharge instructions Interpretation services are crucial to allow the family a final opportunity to clarify any questions they may have prior to discharge MEDICATIONS AND MEDICATION RECONCILIATION Between 12% and 22% of patients not fill medications prescribed from an ED visit Novel approaches such as dispensing medications from the ED pharmacy, especially during late hours when outpatient pharmacy care is limited, may help improve medication adherence Inappropriate dosing and use of medications are related to health literacy deficits, and are also related to morbidity and mortality To help improve medication compliance, names and instructions for use of new medications should be included in discharge instructions Physicians should write in lay terms (e.g., “three times a day” instead of “TID”) For pediatric dosing, consider marking a syringe to show the correct liquid dosing or asking a caregiver to demonstrate the correct way to measure and administer the medication Any changes to a patient’s