Medication discharge education (MDE) is an essential component of the hospital discharge process. It is especially important for older persons with heart disease because they are among the highest users of hospital care. Accurate management of medications is believed to be one strategy to prevent or delay hospitalization. Despite its accepted importance, there is little documented research about patient education in general, or MDE in particular. This ethnographic study collected interview, observational, and document data from older persons with heart disease, family members, nurses and medical records in order to describe the process of MDE. MDE was found to be both structured and unstructured, uncoordinated, and driven by accreditation guidelines. Older patients and their family members valued MDE, especially when information was personalized, provided orally and reinforced in writing. Suggestions for improving the effectiveness of MDE are offered.