Given the increasing value of patient satisfaction in determining the quality of care in the hospital reimbursement model, research is flourishing with a focus on identifying the factors that could positively influence patient satisfaction outcomes.
Patient input and feedback about the quality of care received greater attention than ever as health care delivery transformed to a patient-centered care model.1 As responsible and compassionate health care providers, our top responsibility is to ensure the patient receives the best patient experience.
This includes providing timely and accurate information about treatment plans, maximizing involvement in health care decisions, and ensuring patients understand medical information in a format that is appreciable to them. Given the increasing value of patient satisfaction in determining the quality of care in the hospital reimbursement model, research is flourishing with a focus on identifying the factors that could positively influence patient satisfaction outcomes.2
Proper administration and understanding of potential adverse reactions from medications are keys to patient safety. Each year, adverse drug events are responsible for approximately 700,000 emergency department visits and 100,000 hospitalizations.3
Medication communication and literacy is a major barrier to safe and effective use of drug therapy. According to the National Institute of Medicine, it is estimated half of the United States adult population experienced difficulty with understanding medication instructions.3 Hospitalized patients' understanding of medication indications and adverse effects (AEs) is a major satisfaction indicator on formal surveys which serve as quality measures.4
St. Francis Hospital & Heart Center (SFH) is New York State’s only specialty designated cardiac center, offering one of the leading cardiac care programs in the nation. For the 20th time, the hospital was recognized with an 'A'—the top grade for patient safety—from the Leapfrog Group.
The institution is also the first hospital on Long Island to receive a 5-star rating from the Centers for Medicare & Medicaid Services for consistently high patient satisfaction scores. As part of our institution’s core value to strive for excellence in patient experience, nursing and pharmacy leadership strongly believe patient medication education is imperative to ensure excellence in patient safety and patient experience.
Bedside patient care services at the institution are supported by clinical nurses (CN), pharmacists, care managers, and other ancillary departments. As part of our unit-based pharmacy (UBP) program, a pharmacist is stationed to provide bedside patient care 7.5 hours per day, 2-4 times per week.
The patient’s role in drug therapy is vital because the patient ultimately receives the benefit and the potential harm of a medication. A well informed and educated patient may be able to identify, discern, and seek assistance from providers for minor AEs or possible life-threatening reactions.
The greater the patient’s knowledge of their own care, the better they are empowered to make informed decisions. Patient baseline knowledge of medications, whether newly prescribed or not, and the availability of a consistently effective education program on medication AEs are challenges to improve patient understanding of medications.5
At SFH, the CNs and UBPs noted that the use of multiple drugs and the ability of patients to retain the vast amount of AE information per drug were challenges to patient education. There was a need to utilize a standardized education method that enabled nurses and pharmacists to deliver information in a manner that was understandable to the patient and, at the same time, balanced provider time-constraints. To overcome the challenge, leaders in the Nursing and Pharmacy departments collaborated to develop a task force to address the challenges on medical-surgical telemetry units.
The leaders determined the following values would form the foundation of the task force: interprofessional, shared-governance, inclusion, and patient centeredness. When the values were established, the department leaders formed an interprofessional task force composed of unit-based pharmacists, pharmacy leaders, clinical nurses, nurse managers, and senior nurse leaders.
In this task force, the members identified the outcome (Press Ganey mean score about AE and medication communication) to be improved by the team. Next, the team identified the current state and mapped out current processes.
At SFH, CNs and UBPs provided patient education and counseling on medication AEs upon medication administration and at discharge. Information on medication AEs was provided via verbal counseling. Information leaflets, which included the drug name and a list of associated AEs, were disseminated during counseling.
To further supplement the leaflets, information packets from drug information resources were printed and given to patients. Due to time constraints and staffing challenges, CNs and UBPs were not consistently available on the units to provide education. Furthermore, due to the abundant amount of information that needed to be communicated to patients, staff frequently devoted approximately 30-40 minutes of education time per patient. Hence, it was difficult to provide education to the majority of our patient population on a consistent basis.
The interprofessional task force identified specific challenges linked to each of the current processes and recommended interventions:
Vast number of patients to educate
Due to the volume of patients requiring education, the team decided to provide medication education for 8 of the most common medications patients were prescribed while admitted. Using specific inclusion criteria, the CNs and UBPs streamlined and identified patients to educate during the morning interdisciplinary care coordination rounds.
For patients who met the inclusion criteria, medication education was conducted daily throughout the patient’s admission. The patient was also reeducated immediately prior to discharge.
Many AEs per drug and feasibility of patients to retain vast amount of information
The team recommended educating 2 of the most common AEs per drug. This allowed the team to streamline the amount of information that patients would have to retain and subsequently, the amount of time required to educate each patient.
Inconsistent use of medication leaflets and overwhelming amount of information from drug information leaflets
The team designed new medication education cards, which were laminated and described the AEs in cartoon pictures. The idea was to leverage cartoon pictures to assist patients to retain information about AEs.
The cards were used during medication education sessions. After the session, patients were encouraged to retain the cards for future reference.
Time gap from discharge to patient receiving Press Ganey survey
The team noted there was a gap of no-contact regarding AE education from the time patients were discharged to the time patients received the survey. To bridge the gap and to provide an added level of service to our patients, pharmacists conducted follow-up wellness phone calls to inquire about patient’s status and reinforce their understanding of medication AEs. This intervention also empowered the team to continue the patient-provider relationship post-discharge.
The pilot for the Medication Safety Patient Education Program was launched after the vision, structure, and processes of the program were developed and approved by the interdisciplinary members of the committee. Preliminary data indicated the total number of patients visited by the nursing and pharmacy team were 313, resulting in a total of 375 visits. A total of 137 follow-up phone calls were made.
Although in its early stages, our program illustrated the potential of an interdisciplinary collaboration to improve patient safety and experience with medications. Through a joint effort, pharmacists and clinical nurses provided meaningful contributions to improve patient outcomes. The processes of the program will be continuously monitored and evaluated by the interprofessional team to identity opportunities for further improvement.