I N SP I R I NG CHANGE
A winning hand: Medication cards improve patient safety By Bonnie Haupt, DNP, RN, CHSE, CNL
HEALTHCARE PROVIDERS MUST meet patient expectations of providing safe, high-quality care aimed at improving patient outcomes. This means that healthcare facilities should focus on improving information sharing, communication, and patient understanding regarding the administration of newly prescribed medication. Crucial to providing safe patient care, medication education is a measurable outcome reviewed on patient experience and hospital satisfaction surveys such as Hospital Consumer Assessment of Health Plans Survey, Press Ganey, and Survey of Healthcare Experiences of Patients (SHEP) data bases. Encouraging patient and family involvement in patient care has been identified by The Joint Commission as a critical safety strategy in preventing errors.1 A 2012 National Patient Safety Goal for healthcare workers was to provide, maintain, and communicate accurate medication information to improve patient outcomes. The VA Connecticut Healthcare System created a medication card program to enhance the quality of patient interactions and therapeutic alliances with professional teams in medication administration and education. This article reviews program implementation and results. Shuffle the deck Before creating our pilot project, we conducted a literature review examining the effectiveness and role of
printed information on medications available to patients. The review revealed that most patients had concerns about the poor visual presentation and use of complex language in the medication information provided.2 In most cases, knowledge wasn’t increased by the information provided. Patients weren’t getting the information they wanted about: • adverse reactions • contraindications • medication purpose • how to take the medication properly.2 One study followed up with patients 2 to 6 weeks after discharge. During follow-up calls, researchers learned that only 55% of patients could name their discharge medications and less than 25% could describe adverse reactions or other information pertaining to their medication.3 In a 2011 qualitative study, patients felt that medication information was important only when a new medication was prescribed.4 In another study, educating patients and presenting them with a key-points fact sheet followed by discussion was more beneficial than the use of printed information alone.5 Many researchers agree that starting a new medication can lead to patient misunderstanding and possible adverse events.6,7 VA Connecticut’s initial assessment of SHEP feedback scores related to questions addressing education about new medications and
potential adverse reactions indicated that scores were below the benchmark expectations for our facility. To improve these scores, we decided to implement an evidence-based program that would present patients receiving new medications with a key-points fact sheet followed by discussion. We hoped this strategy would have a greater impact on patient outcomes than the use of written information alone.5 It’s in the cards We first asked our patients, the veterans, what they’d like to know about medications or prescriptions. Responses included: • “Just tell me what my medications are for in simple terms.” • “I’d like to know what the medication is for (if it is new).” • “Give me simple, easy-to-read and understandable paperwork.” • “They printed information for me last time and it was a little small and hard to read.” Next, we identified inadequate medication education as a patient safety risk and earmarked it for a Plan, Do, Study, Act performance improvement project. The interprofessional team members selected for the project included clinical nurses, pharmacists, quality management personnel, a patient experience officer, physicians, nursing administrators, and the clinical nurse leader. The team also collaborated with a local healthcare facility, and a plan was initiated to
18 l Nursing2015 l March
www.Nursing2015.com
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
develop medication information cards that would be given to veterans receiving new medications. At this time, our facility was working closely with the Planetree model for patient experience and Griffin Hospital in Derby, Conn. This hospital had a similar medication card concept and we collaborated with its pharmacy staff to determine the best practice for our veteran population. (For supplemental content, see VA Connecticut Healthcare System sample medication card on the Nursing2015 iPad app.) The medication cards provide basic information about the medication, including general classification, brand and generic names, indications, and adverse reactions. The program was piloted initially with two medication cards on two selected medical-surgical units. Education regarding the intervention was reviewed with all RNs and LPNs. The project plan required all nurses administering a new medication to provide the patient with the appropriate medication card, discuss the information on the
card, and ask if the patient had any questions or would like more detailed information. Then subsequent staff members would ask the patient to “show me your medication card,” and ask if he or she had any questions about the new medication. This applied to nurses on each shift. They would follow up with the veterans even if they weren’t the staff member who gave the original medication cards. Dealing a winner Before the pilot program was implemented, veteran national satisfaction survey questions regarding new medication education and medication education on adverse reactions composite scores (November 2011) were 61.8%. Postpilot medication card implementation data revealed scores increased to 80.2% (end of fiscal year 2012). The pilot was successful, allowing VA Connecticut to reach the benchmark measure. (See Pre- and postimplementation scores.) Fiscal Year 2014 quarter one composite scores were 85.3%.
Pre- and postimplementation scores
1. The Joint Commission. Hospital 2012 National Patient Safety Goals. 2012. http://www.jointcommission. org/assets/1/6/TJC_Measures_2015__11_15.pdf. 2. Raynor DK, Blenkinsopp A, Knapp P, et al. A systematic review of quantitative and qualitative research on the role and effectiveness of written information available to patients about individual medicines. Health Technol Assess. 2007;11(5):iii, 1-160. 3. King JL, Schommer JC, Wirsching RG. Patients’ knowledge of medication care plans after hospital discharge. Am J Health Syst Pharm. 1998;55(13): 1389-1393. 4. Auyeung V, Patel G, McRobbie D, Weinman J, Davies G. Information about medicines to cardiac in-patients: patient satisfaction alongside the role perceptions and practices of doctors, nurses and pharmacists. Patient Educ Couns. 2011; 83(3):360-366.
6. Jack BW, Chetty VK, Anthony D, et al. A reengineered hospital discharge program to decrease rehospitalization. Ann Intern Med. 2009;150(3):178-187.
Percentage
7. Moreland CJ, Kravitz RL, Paterniti DA, Li CS, Lin TC, White RH. Anticoagulation education: do patients understand potential medication-related emergencies? Jt Comm J Qual Patient Saf. 2013;39(1): 22-31.
Percentage of medication outcomes
Bonnie Haupt is the patient experience officer at the VA Connecticut Healthcare System in West Haven, Conn.
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REFERENCES
5. Joanna Briggs Institute. Educational interventions for patients receiving psychotropic medication. Nurs Stand. 2007;22(12):40-44.
Performance measure goal is 80% 100 90 80 70 60 50 40 30 20 10 0
Positive outcome data from hospital surveys and patient experience scores have led VA Connecticut to implement medication card education in all acute care areas with over 15 medication categories, such as opioid analgesics. The staff can now provide the medication cards to veterans as part of regular education or review of current medication. Recently, we’ve included the medication card information in our computerized patient record system. This project has proven within our facility that medication education is crucial to providing safe patient care. ■
This article received appropriate institutional review board and/or administrative approval for publication. The author has disclosed that she has no financial relationships related to this article.
Note: The decrease in July 2012 was due to an issue with printing materials. DOI-10.1097/01.NURSE.0000460729.79859.02
March l Nursing2015 l 19
www.Nursing2015.com
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
A winning hand: Medication cards improve patient safety By Bonnie Haupt, DNP, RN, CHSE, CNL
HEALTHCARE PROVIDERS MUST meet patient expectations of providing safe, high-quality care aimed at improving patient outcomes. This means that healthcare facilities should focus on improving information sharing, communication, and patient understanding regarding the administration of newly prescribed medication. Crucial to providing safe patient care, medication education is a measurable outcome reviewed on patient experience and hospital satisfaction surveys such as Hospital Consumer Assessment of Health Plans Survey, Press Ganey, and Survey of Healthcare Experiences of Patients (SHEP) data bases. Encouraging patient and family involvement in patient care has been identified by The Joint Commission as a critical safety strategy in preventing errors.1 A 2012 National Patient Safety Goal for healthcare workers was to provide, maintain, and communicate accurate medication information to improve patient outcomes. The VA Connecticut Healthcare System created a medication card program to enhance the quality of patient interactions and therapeutic alliances with professional teams in medication administration and education. This article reviews program implementation and results. Shuffle the deck Before creating our pilot project, we conducted a literature review examining the effectiveness and role of
printed information on medications available to patients. The review revealed that most patients had concerns about the poor visual presentation and use of complex language in the medication information provided.2 In most cases, knowledge wasn’t increased by the information provided. Patients weren’t getting the information they wanted about: • adverse reactions • contraindications • medication purpose • how to take the medication properly.2 One study followed up with patients 2 to 6 weeks after discharge. During follow-up calls, researchers learned that only 55% of patients could name their discharge medications and less than 25% could describe adverse reactions or other information pertaining to their medication.3 In a 2011 qualitative study, patients felt that medication information was important only when a new medication was prescribed.4 In another study, educating patients and presenting them with a key-points fact sheet followed by discussion was more beneficial than the use of printed information alone.5 Many researchers agree that starting a new medication can lead to patient misunderstanding and possible adverse events.6,7 VA Connecticut’s initial assessment of SHEP feedback scores related to questions addressing education about new medications and
potential adverse reactions indicated that scores were below the benchmark expectations for our facility. To improve these scores, we decided to implement an evidence-based program that would present patients receiving new medications with a key-points fact sheet followed by discussion. We hoped this strategy would have a greater impact on patient outcomes than the use of written information alone.5 It’s in the cards We first asked our patients, the veterans, what they’d like to know about medications or prescriptions. Responses included: • “Just tell me what my medications are for in simple terms.” • “I’d like to know what the medication is for (if it is new).” • “Give me simple, easy-to-read and understandable paperwork.” • “They printed information for me last time and it was a little small and hard to read.” Next, we identified inadequate medication education as a patient safety risk and earmarked it for a Plan, Do, Study, Act performance improvement project. The interprofessional team members selected for the project included clinical nurses, pharmacists, quality management personnel, a patient experience officer, physicians, nursing administrators, and the clinical nurse leader. The team also collaborated with a local healthcare facility, and a plan was initiated to
18 l Nursing2015 l March
www.Nursing2015.com
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
develop medication information cards that would be given to veterans receiving new medications. At this time, our facility was working closely with the Planetree model for patient experience and Griffin Hospital in Derby, Conn. This hospital had a similar medication card concept and we collaborated with its pharmacy staff to determine the best practice for our veteran population. (For supplemental content, see VA Connecticut Healthcare System sample medication card on the Nursing2015 iPad app.) The medication cards provide basic information about the medication, including general classification, brand and generic names, indications, and adverse reactions. The program was piloted initially with two medication cards on two selected medical-surgical units. Education regarding the intervention was reviewed with all RNs and LPNs. The project plan required all nurses administering a new medication to provide the patient with the appropriate medication card, discuss the information on the
card, and ask if the patient had any questions or would like more detailed information. Then subsequent staff members would ask the patient to “show me your medication card,” and ask if he or she had any questions about the new medication. This applied to nurses on each shift. They would follow up with the veterans even if they weren’t the staff member who gave the original medication cards. Dealing a winner Before the pilot program was implemented, veteran national satisfaction survey questions regarding new medication education and medication education on adverse reactions composite scores (November 2011) were 61.8%. Postpilot medication card implementation data revealed scores increased to 80.2% (end of fiscal year 2012). The pilot was successful, allowing VA Connecticut to reach the benchmark measure. (See Pre- and postimplementation scores.) Fiscal Year 2014 quarter one composite scores were 85.3%.
Pre- and postimplementation scores
1. The Joint Commission. Hospital 2012 National Patient Safety Goals. 2012. http://www.jointcommission. org/assets/1/6/TJC_Measures_2015__11_15.pdf. 2. Raynor DK, Blenkinsopp A, Knapp P, et al. A systematic review of quantitative and qualitative research on the role and effectiveness of written information available to patients about individual medicines. Health Technol Assess. 2007;11(5):iii, 1-160. 3. King JL, Schommer JC, Wirsching RG. Patients’ knowledge of medication care plans after hospital discharge. Am J Health Syst Pharm. 1998;55(13): 1389-1393. 4. Auyeung V, Patel G, McRobbie D, Weinman J, Davies G. Information about medicines to cardiac in-patients: patient satisfaction alongside the role perceptions and practices of doctors, nurses and pharmacists. Patient Educ Couns. 2011; 83(3):360-366.
6. Jack BW, Chetty VK, Anthony D, et al. A reengineered hospital discharge program to decrease rehospitalization. Ann Intern Med. 2009;150(3):178-187.
Percentage
7. Moreland CJ, Kravitz RL, Paterniti DA, Li CS, Lin TC, White RH. Anticoagulation education: do patients understand potential medication-related emergencies? Jt Comm J Qual Patient Saf. 2013;39(1): 22-31.
Percentage of medication outcomes
Bonnie Haupt is the patient experience officer at the VA Connecticut Healthcare System in West Haven, Conn.
2 01
12
r2 be
pt em
Se
Au
gu
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20
12 20
ly Ju
ne
20
12
20 12 Ju
ay
20 12 M
ril
20 12 Ap
ch
20 12 M
ar
ry
Fe
br
ua
ar
y
20 12
01 1 r2 nu Ja
be em
ec
be
r2
01 1
Preimplementation
D
em ov N
REFERENCES
5. Joanna Briggs Institute. Educational interventions for patients receiving psychotropic medication. Nurs Stand. 2007;22(12):40-44.
Performance measure goal is 80% 100 90 80 70 60 50 40 30 20 10 0
Positive outcome data from hospital surveys and patient experience scores have led VA Connecticut to implement medication card education in all acute care areas with over 15 medication categories, such as opioid analgesics. The staff can now provide the medication cards to veterans as part of regular education or review of current medication. Recently, we’ve included the medication card information in our computerized patient record system. This project has proven within our facility that medication education is crucial to providing safe patient care. ■
This article received appropriate institutional review board and/or administrative approval for publication. The author has disclosed that she has no financial relationships related to this article.
Note: The decrease in July 2012 was due to an issue with printing materials. DOI-10.1097/01.NURSE.0000460729.79859.02
March l Nursing2015 l 19
www.Nursing2015.com
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
