1. 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

2. 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.

3. 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.

4. 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.

5. 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.

6. 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)

7. 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)

8. 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).

9. 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.

10. 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

11. 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

12. 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

13. 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

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

15. 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

16. 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%.

17. 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. .

18. 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

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

20. Infection Control Performance Improvement Coordinator
Contact Information
Erika Edwards
MSN, RN, CMSRN
Infection Control Performance Improvement Coordinator
17201 I 45 South
The Woodlands, TX

21. Reference
Burnes, B. (2004). Kurt Lewin and the Planned Approach to Change: A Re-appraisal. Journal of Management Studies, 41: doi: /j x Dhingra, R., & Punia, B. K. (2016). Impact of Organizational Culture on Employees’ Readiness to Change. Journal of Management Research ( ), 16(3), 135–147. Retrieved from direct=true&db=bth&AN= &site=eds-live Dimond, V. J. (2019). The mighty octopus of medication management. Healthcare Purchasing News, 43(4), 14–19. Retrieved from 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 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), Retrieved from Novitskaya, A., & Rajput, M. (2014). Role of Organizational Culture in Creating Readiness for Change Project. Retrieved from direct=true&db=edsndl&AN=edsndl.oai.union.ndltd.org.UPSALLA1.oai.DiVA.org.umu-85603&site=eds-live