Title : Blending caring practice with teaching to improve medication communication
Abstract:
27.6 million Adultsin the United States are diagnosed with heart disease. Prescriptions for multiple cardiac medications typically ensue, and if not taken correctly, can place patients at higher risk for adverse drug events and re-hospitalizations. Consistently providing medication information to patients in a way that is understandable during hospitalization is vital in promoting safe medication administration and adherence behaviors after discharge. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey represents patient perception of the care experience, including interactions with the health care team. These perceptions were used to guide a nurse driven evidenced-based quality improvement project to improve Medication Communication domain scores on a 9 bed Intermediate Coronary Care Unit (CCU), with an expected secondary gain of strengthening CCU and pharmacy collaboration.
Collaboration with pharmacy allowed nursing leadership to pinpoint the top utilized/prescribed medications in the CCU, so tailored medication sheets could be developed. Patients were then provided with these tailored medication teaching sheets, whichwere sorted out by drug class. The nursing specific intervention that is unique to the project is incorporating Duffy’s Quality-Caring-Model caring factors into medication teaching. Nurses took at least 5 minutes per shift, utilizing these medication sheets, to review medication type, purpose, side effects, and answering questions. A dedicated pharmacist was available for consulting on complex medication issues.
In order to ensure the effectiveness of the project, RN compliance with providing the medication sheets was monitored, over a 10 week period, by Leadership during daily rounds. Compliance was identified by speaking with patients, visual inspection of patient room for teaching sheets, and through nursing documentation. The initial goal for this was 80%, but the highest level of compliance reached was 73%.Staff were then updated weekly and based on their feedback, adjustments to the project were made.
The Med-COMM project was implemented on October 1, 2016 and preliminary results were reported out at the end of the December (1st quarter FY2017).
Quarterly HCAHPS Top-Box “Always” scores by received date were compared. Medication Communication domain data showed a dramatic increase from baseline quartile scores obtained in April-June 2016 (26th percentile) to intervention pilot completion quartile October-December 2016 (98th percentile); particularly on questions pertaining to understanding the purpose of medication (66th to 98th percentile) and possible side effects of each medication (12th to 98th percentile).
The initial evaluation and success of this pilot program on CCU has led to continuation and expansion of the program. The program was shared at hospital Nursing Operations and current medication sheets are now being utilized for cardiac patients throughout the facility; withtranslation of materials being expanded to Spanish and Portuguese. The Medication Communication Sub-committee has been charged to implement similar programsfocusing on unit- specific high utilized/prescribed medications; with regular report outs to the Patient Experience Committee for continuous quality monitoring.
A patient-centered approach to redesigning patient educational materials by reinforcing key concepts enhanced medication communication for our cardiovascular patients; therefore enhancing patient satisfaction. This simple intervention which enhanced nurse-patient communication about medications is also expected to have a positive effect on medication adherence and patient outcomes.
Objectives: Provide simple, patient-centered strategies to develop a nurse-driven program addressing medication communication. Page 87 NWC 2017 NWC 2017 2nd Nursing World Conference October 16-18, 2017 Las Vegas, USA Outline how nursing and pharmacy can collaborate to improve patient care, outcomes, and satisfaction; despite limited resources.
Demonstrate how consistently providing medication information to patients in a way that is understandable during hospitalization is vital in promoting safe medication administration and adherence behaviors after discharge, reducing risk for adverse drug events and re-hospitalizations.
