Hospital Accreditation

Did you know that studies have shown that only 48 - 53% of discharged patients can accurately explain the indication for how to take their discharge medications? For pediatric patients, the number is even higher. 66% of parents or caregivers are unable to explain the indication for, dosing, or potential side effects of their child’s medication. That is a scary statistic. Considering that 81% of patients are discharged with a new medication, it is clear there is significant room for improvement. Using medications improperly is a substantial risk for patient harm or readmission. Since education about medication is a part of the HCAHP survey and is included in determining hospital reimbursement through the value-based purchasing reimbursement program, hospitals benefit from providing better medication education. The regulatory standards at 482.43(c)(3) and (5) guide this discussion.

Teaching about medications is a joint responsibility and should begin early during hospitalization. Organizations should identify where the primary responsibility lay; however, physicians, nursing, pharmacy, therapies including respiratory (inhalers), rehab (creams) and wound care would ideally be involved. Begin by assessing the patient’s (and family or caregivers) willingness and ability to learn, including barriers that may impede learning. This should occur at admission or initiation of care. The extent of this evaluation is dependent upon the care setting and scope of service provided, however even outpatient settings should perform a basic assessment.

Many factors may influence the patient’s ability to learn – background, education level, learning style, learning readiness, preconceived ideas, social barriers, and health status. The patient’s own goals are an important part of the teaching plan. A good medication education plan will assess and address each of these factors to assure the patient and or patient representative is discharged with the tools needed to attain their highest level of readiness for aftercare. Make sure the patient’s nursing care plan addresses any education needs and interventions that incorporate the patient’s identified barriers and goals. Appropriate referrals may be necessary to home health or other post discharge providers to assure patients receive the best possible outcomes.

Take credit for the education you provide by documenting both the teaching provided and the patient’s response to the teaching. So often there is documentation of “education provided” to patients who are unresponsive, and the outcome is “unable to comprehend”. While this may fulfill the requirement that education is documented, it is empty documentation. As challenging as it may be, especially during a pandemic, education needs to be given to a responsible caregiver or family member, and reinforced when the patient becomes alert and is able to comprehend. In outpatient settings, talk about the medication by name and by indication. A patient should know the name (generic and trade) of the medication, what it is treating, and any associated side effects they should report. A written list of all medications the patient should be taking with clear indications of changes from the pre-admission medications must be given to the patient, patient’s family, and provided to the post-acute care provider on discharge from both inpatient and outpatient settings. The exception to this requirement is outpatient services that do not administer, prescribe, or manage patient medications.

You may be creative in how patient’s/families are taught. One organization worked with pharmacy to develop index cards on the most commonly prescribed new medications. These were color coded by medication class (color has been shown to have a positive effect on memory!) and kept in the medication room right beside the drug cabinet in a clear plastic slot holder on the wall. Each time a new medication was administered in the hospital, a card was given and reviewed with the patient. Left at the bedside, the cards were used each time the medication was administered, reviewed and reinforced with the patient, encouraging questions. If the patient was discharged on the medication, the cards became part of the discharge information provided. By barcoding the index cards, they could be incorporated into the electronic health record under education provided.

Teaching is a process; a very important part of patient care and a huge step in preventing re-admission. Teaching involves more than just handing the patient a packet of information. Most patients won’t even read it. Technology is great but the interaction between the caregiver and the patient is what really counts. Providing small tidbits of information frequently in layman’s terms will help patients understand. Finally, ensure that all caregivers are on the same page by making education needs a part of daily huddle discussion.

References
Alqenae, F., Steinke, D., and Keers, R. (2020). Prevalence and nature of medication errors and medication-related harm following discharge from hospital to community settings: A systemic review. Drug Safety, 48(6), 517-537. doi: 10.1007/s402624-020-00918-3

Center for Medicare and Medicaid Services. (2020). State Operations Manual, Appendix A – Survey Protocol, Regulations and Interpretive Guidelines for Hospitals. Retrieved from https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_a_hospitals.pdf

Freyer, J., Breiβing, C., Buchal, P., Kabitz, H., ….and Bertsche, T. (2019). Discharge medications – what do patients know about their medication on discharge? Deutsch Med Wochenschr, 141(15), 150-156. doi: 10.1055/s-0042-108618