Patient Medication Education At Discharge Erika Edwards, MSN, RN, CMSRN Infection Control Performance Improvement Coordinator Irene Amimo, MSN, RN Jennifer Embree, DNP, RN, NE-BC, CCNS Wendy Miller, PhD, RN, CNS, CCRN, FAAN October 16, 2019 Houston Methodist the Woodlands

Objectives Identify ways to decrease barriers to medication education at discharge. Identify resources to assist the nurses on medication specifics. Demonstrate an evidence-based way for educating patients on medications at discharge.

Background/Rationale The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey results revealed the local Medical Surgical unit scored 42.6% in patient satisfaction in relation to medication education at discharge.

Purpose of the Project To describe the process used to deliver patient discharge medication education The goal of the project was to increase the knowledge of patients in relation to their medications, and potentially increase the HCAHPS medication survey scores.

Project Definition Decreasing the barriers to medication education at discharge To educate the nurses on the importance of meeting the patient’s needs. Educating patients on their medications empowers them with adequate knowledge, which increases compliance.

A Readiness to Change Change is not effective without the efforts and commitment of everyone within an organization Organizational culture builds a foundation for implementing change and creates readiness for a change project through the mediation of change management efforts (Novitskaya & Rajput, 2014) Organizational culture can be explained as a system of shared values and beliefs held by members that differentiate the organization from other organization (Dhingra & Punia, 2016)

Lewin’s 3-Step Model of Change Step 1: Unfreezing – behaviors must be destabilized (unfrozen) and discarded before new behavior can be adopted Step 2: Moving – moving from a less acceptable to a more acceptable set of behaviors Step 3: Refreezing – stabilize new behaviors to avoid regression (Lewin, 1947a)

Literature Review Nearly 26 percent of hospital readmissions are a result of patients being unclear on how to take their medications after discharge (Dimond, 2019) Patient education about medication is a salient and important prerequisite for safe and effective medication administration (Latter et al, 2001). Lack of adequate written information and time constraints may hinder nurses’ efforts to educate patients about how to take their medications after discharge (ISMP, 2004).

Methodology One-on-one interviews were conducted with the nursing staff using the following questions to assess for barriers. 1. Do you have a clear understanding of the medication education discharge process? 2. Are you performing this task during every discharge? 3. What are the barriers to patient education on medications at discharge? 4. What suggestions do you have on the discharge process in relations to medication education? 5. What resources do you utilize to customize the discharge instructions related to medications the patients will take after discharge? A six-week timeline was established. A six-week timeline was established.

Methodology cont…. Nurses searched the Lexicomp and Krames medication sites through the electronic health record. An educational demonstration on the discharge process was provided to all nurses. Each nurse was observed conducting a medication education discharge process with a patient. - If remediation was needed, it was accomplished at the time of the observation

Methodology cont… Post knowledge assessment of five questions was performed at the end of the educational intervention. 1. Has the new discharge process decreased initial barriers? 2. Has the education and demonstration for accessing medication resource sites been beneficial? 3. Do you have any suggestions to modifying the new process to make it a better flow? 4. Do you feel more confident about educating the patients on their medication during the discharge process? 5. Are you performing the discharge process during every discharge? Newly hired nurses were educated on the suggested medication education process during orientation

Needs Assessment & Impact Analysis Strategic Impact Input from patient/community- 42.6% were not satisfied with the medication education How will this program/PEI make a difference for the patient? This will reduce barriers to medication education process Increase patients knowledge related to medications Patient Care Quality Indicators HCAHPS survey scores Readmissions related to medication non-compliance Clinical Impact Market Impact Five-Year Analysis Magnet Status No Capital Requirements Total reimbursement for patient care from the Centers for Medicare & Medicaid Services Identify ways to decrease barriers to medication education, while increasing nurses knowledge on medication discharge process within 6 weeks. Increase patients knowledge related to medication education Programmatic Impact Needs Assessment & Impact Analysis Project Success Factors Increased nurse and patient knowledge to medication education Increased HCAHPS survey scores How will this project/PEI make a difference for the: Reduce barriers for nurses in relations to the medication education process at discharge Implement a more effective medication education discharge standard workflow Strengths: Project meets patient needs Opportunities: Increase nurses and patients knowledge in relations to medication education Weaknesses-Socioeconomic status impacts medication compliance Threats: Decreased patient satisfaction in relations to medication education at discharge Decreased medication compliance GOALS & OBJECTIVES

3-Step Change Model For Medication Education At Discharge Unfreezing Change Refreezing Interview nursing staff on barriers HCAHPS scores Review of current process Educate nurses Demonstrations Resources Observation Continued evaluation of process New hire orientation HCAHPS scores

Discussion Implemented educational interventions enhanced the medication discharge process. Increased patient medication education satisfaction scores were met. .

Plan for Improvement Evaluate patients understanding: Provide nurses with adequate resources related to medications: - Lexicomp - Krames Integrated the new discharge/education process into the new nurse orientation Evaluate patients understanding: - Teach back - Have patient provide 1 side effect for each medication - Ask patient if there are any questions related to medications

Results/Outcomes HCAHPS survey results released mid July revealed an increase in patient satisfaction in relation to medication education at discharge, with a score of 82.3%.

Results/Outcomes Cont…. Success of the project was a result of: - The 6N staff’s readiness for change - Used the literature and nurse input to identify the best evidence for process change - Commitment to implementing inventions - Assessing patient’s understanding - Evaluating effectiveness of the change process. .

Conclusion Using evidence and nurse input regarding barriers to identify the best practice discharge medication education process was effective in improving the nurse’s workflow and discharge medication process compliance

Lessons Learned Readiness to change was key to successful medication education An organization’s culture greatly affects its employee’s readiness for change.

Infection Control Performance Improvement Coordinator Contact Information Erika Edwards MSN, RN, CMSRN Infection Control Performance Improvement Coordinator 17201 I 45 South The Woodlands, TX. 77385 317-362-2063

Reference Burnes, B. (2004). Kurt Lewin and the Planned Approach to Change: A Re-appraisal. Journal of Management Studies, 41: 977-1002. doi:10.1111/j.1467-6486.2004.00463.x Dhingra, R., & Punia, B. K. (2016). Impact of Organizational Culture on Employees’ Readiness to Change. Journal of Management Research (09725814), 16(3), 135–147. Retrieved from https://search-ebscohost-com.proxy.ulib.uits.iu.edu/login.aspx direct=true&db=bth&AN=120088655&site=eds-live Dimond, V. J. (2019). The mighty octopus of medication management. Healthcare Purchasing News, 43(4), 14–19. Retrieved from https://search-ebscohost-com.proxy.ulib.uits.iu.edu/login.aspx?direct=true&db=bth&AN=135687978&site=eds-live Institute for Safe Medication Practices Institute for (ISMP) (2004). Survey Reveals Nurses’ Difficulty With Medication Education. Journal of Psychosocial Nursing & Mental Health Services, 42(1), 11. Retrieved from https://search.proquest.com/docview/225544551?accountid=28024 Latter, S., Rycroft-Malone, J., Yerrell, P., & Shaw, D. (2001). Nurse’s Educational Preparation For a Medication Education Role: Findings from a national survey. Nurse Education Today. Vol. 21 (2), 143-154. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107054463&site=ehost-live Novitskaya, A., & Rajput, M. (2014). Role of Organizational Culture in Creating Readiness for Change Project. Retrieved from https://search-ebscohost-com.proxy.ulib.uits.iu.edu/login.aspx? direct=true&db=edsndl&AN=edsndl.oai.union.ndltd.org.UPSALLA1.oai.DiVA.org.umu-85603&site=eds-live