1. Enhanced Patient-Safety Intervention To Optimize Medication Education (EPITOME) Carl Sirio, MD Professor Critical Care Medicine, Medicine and Pharmacy and Therapeutics University of Pittsburgh Schools of Medicine and Pharmacy

2. AHRQ 2007 Annual Conference…Implementing Medication Safety Tools at Critical Junctures What Are We Trying to Accomplish? Specifically: Increase patients’ perception of (satisfaction with) the delivery of medication education while in the hospital Simplify medication regimens as appropriate Decrease hospital readmissions Our aim was to develop a collaborative management approach by pharmacists, nurses, and respiratory therapists to provide standardized patient education on medication use.

3. AHRQ 2007 Annual Conference…Implementing Medication Safety Tools at Critical Junctures Objectives Describe the safety problem EPITOME description Conceptual framework Pilot results Implementation of “education for all” Outcomes of interest Lessons learned Successes Barriers and challenges Pending results/next steps

4. AHRQ 2007 Annual Conference…Implementing Medication Safety Tools at Critical Junctures Defining the Safety Problem 11% of all hospital admissions are due to medication complications Dunbar-Jacob 2001 Inadequate patient medication education is a common reason for non- adherent behaviors and is an independent risk factor for unplanned 30- day hospital readmission Haynes 2004, Marcantonio 1999 U.S. and Canadian studies have documented inconsistencies in the medication education component of hospital discharge resulting in poor patient knowledge of their medications Alibhai 1999, King 1998, Cortis 1996 Barriers to hospital-based medication education by pharmacists include lack of time, no organized or systematic program for education, and inadequate discharge notification Griffith 1998

5. AHRQ 2007 Annual Conference…Implementing Medication Safety Tools at Critical Junctures The Safety Problem Medication adherence – “the extent to which a patient’s behavior is consistent with health care recommendations.” Pilot results Multidisciplinary education and consultation improved: Specific medication knowledge

6. AHRQ 2007 Annual Conference…Implementing Medication Safety Tools at Critical Junctures Specific Knowledge About Medication

7. AHRQ 2007 Annual Conference…Implementing Medication Safety Tools at Critical Junctures The Safety Problem Medication adherence – “the extent to which a patient’s behavior is consistent with health care recommendations.” Pilot results Multidisciplinary education and consultation improved: Specific medication knowledge Satisfaction with medication use education

8. AHRQ 2007 Annual Conference…Implementing Medication Safety Tools at Critical Junctures Global Satisfaction with Medication Education

9. AHRQ 2007 Annual Conference…Implementing Medication Safety Tools at Critical Junctures The Safety Problem Medication adherence – “the extent to which a patient’s behavior is consistent with health care recommendations.” Pilot results Multidisciplinary education and consultation improved: Specific medication knowledge Satisfaction with medication use education Self reported adherence

10. AHRQ 2007 Annual Conference…Implementing Medication Safety Tools at Critical Junctures Patients are not receiving adequate medication education before leaving the hospital Hard to predict LOS High patient acuity and number of medications Inconsistent knowledge of resources Inconsistent availability of teaching tools Patient Health Care Team Resources Methods Staffing Shortages Little collaboration amongst disciplines Patient education left to day of discharge Variability in the degree/amount of education High census and patient turnover Generic teaching documentation forms The Safety Problem

11. AHRQ 2007 Annual Conference…Implementing Medication Safety Tools at Critical Junctures The Intervention - EPITOME Conceptual framework There are three basic tools of medicine…”the herb, the knife and the word.” Health behavior change model Educate – rapport, verbal/written Reinforce – comprehension, consult Evaluate - barriers

12. AHRQ 2007 Annual Conference…Implementing Medication Safety Tools at Critical Junctures EPITOME Patient needs assessment of: Oral medications Routine patient needs Complex medication regimens  Pharmacist consultation

13. AHRQ 2007 Annual Conference…Implementing Medication Safety Tools at Critical Junctures EPITOME Education for “all patients” Timing Exclusion Surrogates Multidisciplinary approach Medicine Nursing

14. AHRQ 2007 Annual Conference…Implementing Medication Safety Tools at Critical Junctures Define the role of everyone within EPITOME Role of the Nurse/Nursing Unit Give patients a medication education folder upon admission Print Medication Education leaflets with each new medication and give them to the patient Educate EVERY patient on their medications at each medication administration Review the following throughout the hospital admission utilizing the health behavior change model:  Medication name and indication  How to take it (number of times per day)  Any special administration instructions (take with food)  Common side effects Document Medication Education every day

15. AHRQ 2007 Annual Conference…Implementing Medication Safety Tools at Critical Junctures EPITOME Education for “all patients” Timing Exclusion Surrogates Multidisciplinary approach Medicine Nursing Pharmacy

16. AHRQ 2007 Annual Conference…Implementing Medication Safety Tools at Critical Junctures Define the role of everyone within EPITOME Role of the Pharmacist Educate patients ordered 10 or more oral medications Educate patients identified by the nursing staff who need additional education Review the following utilizing the health behavior change model: Medication name and indication How to take it (number of times per day) Any special administration instructions (take with food) Common side effects Document Medication Education and provide medication management modifications within the Progress Note Section of the patient chart

17. AHRQ 2007 Annual Conference…Implementing Medication Safety Tools at Critical Junctures EPITOME Education for “all patients” Timing Exclusion Surrogates Multidisciplinary approach Medicine Nursing Pharmacy Respiratory Therapy

18. AHRQ 2007 Annual Conference…Implementing Medication Safety Tools at Critical Junctures Define the role of everyone within EPITOME Role of the Respiratory Therapist Educate all patients on an inhaled medication at each medication administration Review the following throughout the hospital admission utilizing the health behavior change model:  Medication name and indication  How to take it (number of times per day)  Any special administration instructions (take with food)  Common side effects Document Medication Education within the respiratory treatment log form available on the patient clipboard

19. AHRQ 2007 Annual Conference…Implementing Medication Safety Tools at Critical Junctures EPITOME Training & staffing Patient materials Links to HIT Medical record documentation Auditing implementation performance Trouble shooting Rapid sequence performance improvement efforts

20. AHRQ 2007 Annual Conference…Implementing Medication Safety Tools at Critical Junctures EPITOME Outcomes assessment Patient satisfaction and awareness

21. AHRQ 2007 Annual Conference…Implementing Medication Safety Tools at Critical Junctures Patients’ Perception of (satisfaction with) the Delivery of Medication Education While in the Hospital Threshold=4

22. AHRQ 2007 Annual Conference…Implementing Medication Safety Tools at Critical Junctures EPITOME Outcomes assessment Patient satisfaction and awareness Medication error identification and prevention Complexity of medication regimen (simplification) Hospital readmission

23. AHRQ 2007 Annual Conference…Implementing Medication Safety Tools at Critical Junctures EPITOME – Lessons Learned Successes Pharmacist interventions and consultations Respiratory Therapy teaching Patient awareness of their medications Under assessment Simplification of complex medication regimens Hospital readmissions

24. AHRQ 2007 Annual Conference…Implementing Medication Safety Tools at Critical Junctures EPITOME – Lessons Learned Barriers Nursing workflow and teaching: “shifting the cultural paradigm” from teaching at discharge to teaching over time – “titration and dosing” of educational efforts HIT barriers Producing useful educational materials for the bedside The “information quality” issue

25. AHRQ 2007 Annual Conference…Implementing Medication Safety Tools at Critical Junctures Dissemination Steps What worked What needs to be improved