Improving Medication Education Catherine Lopez BSN, RN medical/oncology

Why the Quality of Information about Medications Matter Facts Consequences 72% of patients discharged aren't able to recite their med list 1.5 million Americans are injured each year from medicine errors in healthcare facilities Nearly 1 in every 5 patients experiences an adverse event after being discharged Average adult needs to be exposed to new info at least 3x in order to commit to memory New medications cause anxiety Not knowing enough about the side effects puts patients in danger What to do should they experience side effects Poor clinical outcomes

GOAL: UNIT SCORE of 80% Increase HCAHPS Score by 10% Over 6 Months Nurse survey Examine techniques of the process Explore alternatives Investigate causations of scores Identify, if any, the association between HCAPS scores and the nurse variance reports over the expansion of 12 months.

PLAN Simplify medication education Nurse/patient roles Name of medication Reason for medication Dosage Route Duration Common side effects Begins on admission Readiness to learn- ID any barriers to learning Clear communication Patient and family caregiver Minimize environmental distractions Teach back Verbalize understanding Reinforce by all appropriate staff members Print outs & highlighting

Communication about Medications

Nurse Variance Scores January- December 2016

HCAPS Score compared with Nurse Variances

Benefits of Well Educated Patients Safe transition home A partner in their own care Place them at ease Impact their perception of care Compliance with treatment Ensuring national patient safety goals Visual reminder of medication regimen Better clinical outcomes

Conclusion Effective education about medications is particularly important during discharge as it’s the last time teach back can occur between health care provider and patient. The education must be clear and comprehendible so that the patient has enough knowledge to support adherence to the medication regiment, otherwise, the patient may fall to misconceptions. Evidence based studies and best practices supported a set of guidelines which I used to draft a standardized approach when delivering education to our patients. The objective is to minimize re-admissions, improve patient safety, increase patient satisfaction, and ultimately improve patient outcomes on TT7. The data shows that HCAPS scores occasionally were related to monthly score, however, was found inconclusive due to limited analysis time- meaning12 month time span. If allowed I would like to continue research on this topic to create a “discharge bundle.”

The Breakdown of Data monthly

Nurses Needed Based on Acuity System vs Staffed Nurse Variance Report March 2016 variance 1 variance 2 variance 3 variance 4 Nurses Needed Based on Acuity System vs Staffed Census Needed Staffed 12 days 1 days 15 day total: 19 Variance Days 77.8%

Nurse Variance Report April 2016 #s matched: LVN with patients 2: LVN with patients & short 1 staff Nurse Variance Report April 2016 Variance 1 Variance 1 + Variance 4 Variance 1 + Variance 4 (2) Nurses Needed Based on Acuity System vs Staffed Nurses Needed Based on Acuity System vs Staffed Census Needed Staffed Census Needed Staffed 3 days 5 days 2 days total: 13 Variance Days 75%

Nurse Variance Report May 2016 Variance 1 Variance 1 + Variance 4 Variance 1 + Variance 4 (2) Census Needed Staffed Nurses Needed Based on Acuity System vs Staffed Nurses Needed Based on Acuity System vs Staffed Census Needed Staffed Census Needed Staffed 3 days 8 days 4 days total: 18 Variance Day 70%

Nurses Needed Based on Acuity System vs Staffed Nurse Variance Report June 2016 Variance 1 Variance 1 + Variance 4 Variance 1 + Variance 4 (2) Variance 4 Nurse Variance Rport June 2016 #s matched: LVN with patients #s not matched by 1: no LVN to work #s not matched by 2: LVN with pa Nurses Needed Based on Acuity System vs Staffed Census Needed Staffed 1 day 8 days 1 day total: 10 Variance Days 92.3%

Nurses Needed Based on Acuity System vs Staffed Nurse Variance Report July 2016 Variance 1 Variance 1 + Variance 4 Variance 1 + Variance 4 (2) Variance 2+ Variance 4 Variance 4 Nurse Variance Report July 2016 #s matched: LVN with patients #s not matched by 1: no LVN to work #s not matched by 2: LVN with patie Nurses Needed Based on Acuity System vs Staffed Census Needed Staffed Census Needed Staffed 14 days 4 days 6 days total: 26 Variance Days 67.3%

Nurses Needed Based on Acuity System vs Staffed Nurse Variance Report August 2016 Variance 1 Variance 1 + Variance 4 Variance 1 + Variance 4 (2) Nurse Variance Report August 2016 #s matched: LVN with patients #s not matched by 1: no LVN to work #s not matched by 2: LVN with patients & short 1 staff Nurses Needed Based on Acuity System vs Staffed Census Needed Staffed Census Needed Staffed 6 days 13 days 2 days total: 26 days short 75 %

Nurse Variance Report September 2016 #s matched: LVN with patients No LVN Difference of 1: LVN assigned & short 1 staff Difference of 2: LVN assigned & short 2 Nurse Variance Report September 2016 #s matched: LVN with patients #s not mwork #s not matched by 2: LVN with patients & short 1 staff Nurses Needed Based on Acuity System vs Staffed Nurses Needed Based on Acuity System vs Staffed Census Needed Staffed Census Needed Staffed 84.6%

Nurses Needed Based on Acuity System vs Staffed Nurse Variance Report October 2016 #s matched: LVN with patients No LVN Difference of 1: LVN assigned & short 1 staff Difference of 2: LVN assigned & short 2 Nurse Variance Report October 2016 #s matched: LVN with patients #s not matched by 1: no LVN to #s not matched by 2: LVN with patients & short 1 staff Nurses Needed Based on Acuity System vs Staffed Census Needed Staffed Census Needed Staffed 83.3%

Nurses Needed Based on Acuity System vs Staffed Nurse Variance Report November 2016 #s matched: LVN with patients No LVN Difference of 1: LVN assigned & short 1 staff Difference of 2: LVN assigned & short 2 Nurse Variance Report November 2016 #s matched: LVN with patients #s not matched by 1: no LVN to work #s not matched by 2: LVN with patients & short 1 staff Nurses Needed Based on Acuity System vs Staffed Census Needed Staffed Census Needed Staffed 75.7%

Nurses Needed Based on Acuity System vs Staffed Nurse Variance Report December 2016 #s matched: LVN with patients No LVN Difference of 1: LVN assigned & short 1 staff Difference of 2: LVN assigned & short 2 Nurse Variance Report December 2016 #s matched: LVN with patients VN to work #s not matched by 2: LVN with patients & short 1 staff Nurses Needed Based on Acuity System vs Staffed Census Needed Staffed Census Needed Staffed 75%

Nurses Needed Based on Acuity System vs Staffed Nurse Variance Report January 2016 #s matched: LVN with patients No LVN Difference of 1: LVN assigned & short 1 staff Difference of 2: LVN assigned & short 2 Nurse Variance Report January 2017 #s matched: LVN with patient #s not matched by 1: no LVN to work #s not matched by 2: LVN with patients & short 1 staff Nurses Needed Based on Acuity System vs Staffed Census Needed Staffed Census Needed Staffed

Nurses Needed Based on Acuity System vs Staffed Nurse Variance Report February 2016 #s matched: LVN with patients No LVN Difference of 1: LVN assigned & short 1 staff Difference of 2: LVN assigned & short 2 Nurse Variance Report February 2017 #s matched: LVN with #s not matched by 1: no LVN to work #s not matched by 2: LVN with patients & short 1 staff Nurses Needed Based on Acuity System vs Staffed Census Needed Staffed Census Needed Staffed

References O’Leary, King J., et al. “Hospitalized Patients’ Understanding Of Their Plan of Care” Mayo Clinic Proceedings 85, no.1 (2010):47-52.) Studer, Q., Robinson, B. C., & Cook, K. (2010). The HCAHPS handbook: Hardwire you hospital for pay-for-performance success. Gulf Breeze, FL: Fire Starter Pub.