1. Promoting Medication Adherence: The Nursing Role
By: Katey MacCormack

2. The Big Picture
Patient non adherence with prescription medications results in 10% of hospitalizations and 125,000 deaths per year.
46% of Americans have chronic conditions requiring long-term use of maintenance medications
Non-Adherence: New Insights. Express Scropts: Drug Trend Report. (2013). Retrieved from
For example, a patient with congestive heart failure failing to take their diuretic as. prescribed could potentially be hospitalized for fluid overload. Therefore, adding to the healthcare expenditure.

3. Causes of Non Adherence
Lack of knowledge:
Unsure how or when to take the medication
Health State
Fear of side effects
“I feel good, therefore I don’t need the medication”
Lack of support
No one to prompt or assist
Illiteracy
Cannot read or understand the instructions
Access
No access to pharmacy for refills
Cost

4. Reasons For Not Filling Prescriptions
Cost of the drug
40%
Side effect of drug
11%
Thought drug wouldn’t help much
Didn’t think I needed it 8%
Drug did not help 6%
Don’t like taking prescription drugs 5%
Condition improved 4%
Already taking too many precriptions 3%
Source: Prescription Drug Use Among Midlife and Older Americans, AARP, December 2004

5. Characteristics of Non Adherence: What to look for as Nurses
Objective tests that suggest non compliance– lab tests, physical exams, vital signs, etc
Development of complications
Ex: pulmonary edema in CHF patients failing to take their prescribed diuretics
Exacerbation of symptoms
Ex: a patient on an antihypertensive regimen presenting to the ED with excessively high blood pressure after a fall at home
Repeated hospital admissions
Missed appointments
No therapeutic effect
Ex: consistently high cholesterol levels in a patient prescribed Lipitor

6. Most Common Interventions
Medication organizers
Electronic pagers/ timers
Morisky Scale self survey

7. Implications for Nursing
Often times nurses are the members of the healthcare team communicating the most with the patient.
The nurse’s role is to advocate for her patient in order to improve their health outcome.
Nursing interventions regarding medication adherence
1) Ongoing assessment
2) Therapeutic Interventions
3) Education

8. Asses the patient’s perceptions of their own health problems
Some patients believe they are “cured” because they feel well at the moment
What does the patient believe is causing his/her disease symptoms?
Assess religious beliefs or practices that could affect health
Determine reasons for past issues with non compliance
Ask patient to bring prescriptions to the appointment
Asses blood levels
Ongoing Assessment

9. Therpeutic Interventions
Develop a therapeutic relationship with the patient and their support systems
Trusting relationships can enhance adherence
Make the patient a “co-manager” of their own treatment
Gives the patient a sense of control over their own treatment
Adjust therapy to the patient’s lifestyle
Increase supervision
Home health aides, telephone monitoring, frequent visits
Therpeutic Interventions

10. Collaborate with other healthcare professionals regarding best methods for educating
Assess patient’s level of literacy and ability to understand instructions
Tailor to patient’s level of knowledge by use of visual aides or assistive programs
Take language barriers into account
Teach not only the patient, but the patient’s support system
Explore community resources
Serve as a bridge between the patient and the healthcare provider
Actively assess patients knowledge regarding dosing, timing, and reasons for use of medications
Education

11. References
Fung, B.(2012, September 11). The $289 Billion Cost of Medication Noncompliance, and What to Do About It. The Atlantic.
Non-Adherence: New Insights. Express Scropts: Drug Trend Report. (2013). Retrieved from solutions/nonadherence-new-insights
Reasons for Medication Non-Adherence. MTS Medication Technologies. (2012). Retrieved from mt.com/learning/medication-adherence the_reasons_for_non_adherence/
Zurlinden, J., & Gulanick, M. (2012). “NANDA: A patient’s informed decision to not to adhere to a therapeutic recommendation”. Elsevier Nursing Care Plans, 5th edition.

12. Reflective Note
In all of the orientations I have done for my co-op jobs, the most common way that information is passed on is through a PowerPoint presentation. I chose this genre because I believe it is the most effective method for getting the point across. A PowerPoint presentation can be shown to a large group of people in one room with one presenter, therefore maximizing effectiveness regarding getting the information across. There are also many different angles that can be taken when creating the presentation including use of visual aids and strategic wording to keep the audience captivated. When it comes to creating a presentation for other medical professionals it is important to keep the presentation concise yet informative. Sine the audience is full of people with the same common knowledge it is important to be sure not to repeat information that the audience will already be aware of because this will lose the attention of the audience. It is essential to also remain factual and to the point. I think I did a good job of this in my presentation. I feel I remained informative and factual yet concise.
In terms of the content, I wanted to focus on the nursing role. In order to do that, I had to make a point regarding the importance of promoting medication adherence beyond the usual patient care reasons. Nurses should be thinking not only in terms of patient care, but also in terms of innovation and change for the future. Understanding the reasons for non adherence can help to fix the problem. The specific nursing interventions in slides 8-10 are the big takeaways from the presentation because that is what is gong to fix the problem.
A presentation like this would most likely be found at a meeting in a doctor’s office or possibly at an educational institution geared at raising health outcomes for patients. Medication adherence is an issue that affects all areas of healthcare, so it could really be addressed anywhere. I would like to include this piece in my final portfolio because I feel like it accurately portrays the professionalism I am capable of creating which is an important skill for my career.