Improving satisfaction by 10% of patients prescribed new medications in a neuro-medical surgical unit utilizing individualized medication cards over a 90-day period.
During the cause of patient hospital stay, many interaction occur between the patients and nurses, as well as the provision of education on medication side effects. The nurses are held responsible for educating patients on their care, and ensuring that effective communication is enhanced. This is a skill that has been found to be linked to improved patient satisfaction and outcome. One of the ways nursing can affect healthcare outcomes is to promote healthcare literacy by improving the way nurses provide medical information to patient and families (Potter & Martin, 2005).This can be challenging for patients with cognitive deficits resulting from different neurological conditions. Third-party providers now associate reimbursement to quality care measures, in an attempt to reduce cost while still maintaining good outcome (American Nurses Association, 2007).Paying for performance is currently being used to ensure that organizations pay attention to quality problems that need improvement. These are collected as performance measures, and are processed as patient satisfaction data used by patients in determining where to go for their healthcare. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a standardized tool that measures patient satisfaction on their perspective of hospital care. It was developed by the Agency for Healthcare Research and Quality to evaluate a patient’s perspective of hospital care (Center for Medicare & Medicaid Services [CMS], 2012).Since this tool was developed, it has become a means of collecting and comparing data on patients’ perspectives of inpatient care received in the hospitals nationally (CMS, 2012).Patient satisfaction regarding education on medication indication and side effects is an important domain in the HCAHPS survey. Systematic review by Hafsteinsdottir, Vergunst, Lindeman, & Schuurmans (2001), identified that patients want to be told about the indication and side effects of their medications after a stroke incident. The studies by Borgsteede et al, after reviewing information from an interview with patients from cardiology, pulmonology, and internal medicine, indicated that patients desired to be told about indications and side effects of their medication so as to be prepared when they experience them (2011).They found that important side effects of medications were not explained to patients in a way that patients would understand. Morrow, Weiner, Young, Steinley, Deer, & Murray,(2005) in their study specified the need for simplification of the educational materials to accommodate the declining cognitive abilities of patients with cognitive problems by utilizing communication tools made in simple language, short sentences, simple syntax, organization method that improves comprehension and pictures to aid the comprehension of medication instructions. To meet the learning needs of patients with cognitive deficit who are 18 years and older, an individualized standardized 16-fonted medication cards in fifth to sixth grade level, have been shown to improve medication knowledge, utilizing the method of teach back and spaced retrieval teaching strategies (Peterson, Takiya, & Finley, 2003; Vance et al., 2008; Rush-Monroe, 2011; George, Elliott, & Stewart, 2008;Hayes,1998;Morrow,Weiner,Young,Steinley,Deer,& Murray,2005;Stenocypher,2009;Morrow,Carver,Leirer,& Tanks,2000;Burge et al,2005).
Background and Significance
There is an increased awareness towards reducing hospital readmission to reduce health care cost and improve quality of care. Readmissions post hospital discharges are indicators of the quality of care provided in the hospital for different medical conditions. The Centers for Medicare and Medicaid Services (CMS) reports hospital-level risk-standardized 30-day readmission rates for these conditions to enable health care consumers decide where to get care and to promote quality improvements in our hospitals. In October 2012, they created an incentive fund to award to hospitals based on their performance on several quality measures; 30% of the fund is based on patient’s hospital experience on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction survey. The goal of HCAHPS is to create incentives for hospitals to improve their quality of care and enhancing the public accountability and transparency of the quality of hospital care. Evidence shows the relationship between patient satisfaction and decreased readmission rate (Boulding, 2011). Readmission is estimated to cost 17.4 billion dollars yearly. The same study considered a patient- centered information to be of the importance with evaluation and management of hospital performance. Organizations are expected to meet patient needs while providing care because patient satisfaction is an important tool for a flourishing organization (Counts & Mayolo, 2007). Patients are dissatisfied with the overall care when they are not provided with the side effects of their treatments. This is found to be possibly related to low health literacy. It is estimated that about 36% of adults are below or at basic literacy levels with 59% of adults 65 year and older making up this number (Laramee, Morris, & Littenberg, 2007; National Assessment of Adult Literacy [NAAL], 2005). Health literacy is defined as a set of skills needed to read, understand and utilize simple health-related materials in every day health decision making (Eadie,2014;Center for Disease & Prevention,2011a;NAAL,2005).The understanding of a patient’s health literacy enables the nurse to provide appropriate educational materials and approach the topic of patient education in a way that will enhance learning. Cotugna,Vickery,& Carpenter-Haefele (2005) surveyed patient’s educational materials and found that only about 20% of the materials were written at the appropriate recommended level which is fifth to sixth grade reading level. Education for patients with cognitive problems need to be targeted towards specific educational needs since it impacts the ability to learn, making their educational needs different from other chronic diseases. More so, appropriate educational instructions and materials are important to meet the educational needs of patients with cognitive impairment. Comorbidities and medications used to treat them in addition to the cognitive impairment contribute to even poorer cognitive functioning (Vance et al, 2008; Vance, Larsen, Eagerton, & Wright, 2011).It is imperative that nurses comprehend the cognitive deficits of these patients and provide appropriate strategic intervention. One identified way of educating the cognitively impaired patient is the spaced retrieval technique, which involves initially memorizing a short piece of information and recalling it immediately. The patient is then asked to recall the information over a period of time (Vance & Farr, 2007).This method has been used in aging adults with stroke, dementia, and HIV.The teach-back method is another identified method of assessing and promoting patient understanding of information. This method of teaching ensures understanding and application of received information by asking patients to repeat things that have been taught in their own words (Mayer & Villaire, 2009; Rush-Monroe, 2011). There is therefore a need for an individualized medication education tool that will accommodate the learning needs of patients with declining cognitive capability using standardized medication cards to enhance HCAPHS scores on patient satisfaction, reduce readmission, medication error, and increased health outcomes.
Articles on Evidence with Medication Cards
Burge, S., White, D., Bajore, E., Bazaldua, O., Trevino, J., Albright, T., … Cigarroa, L. (2005). Correlates of medication knowledge and adherence: Findings from the residence research network of south texas. Family Medicine, 37(10), 211-218.
Centers for Medicare & Medicaid Services. (2012). Quality assurance guidelines. Retrieved from http://www.hcahpsonline.org
Conn, V. S., Hafdahl, A. R., Cooper, P. S., Ruppor, T. M., Mehr, D. R., & Russel, C. L. (2009). Interventions to improve medication adherence among older adults: Metaanalysis of adherence outcomes among randomized controlled trials. The Gerontologist, 49(4), 447-462.
George, G., Elliott, R. A., & Stewart, D. C. (2008). A systematic review of interventions to improve medication taking in elderly patients prescribed multiple medications. Drugs and Aging, 25(4), 307-324.
Hayes, K. S. (1998). Randomized trial of Geragogy-Based medication instruction in the emergency department. Nursing Research, 47(4), 211-218.
Peterson, A. M., Takiya, L., & Finely, R. (2003, April 1). Meta-analysis of trials of interventions to improve medication adherence. American Journal of Health-System Pharmacy, 60(7), 657-9.
Articles on HCAHPS
Elliott, M. N., Zaslavsky, A. M., Goldstein, E., Lehrman, W., Hambarsoomians, K., Beckett, M. K., & Giordano, L. (2008). Effects of survey mode, patient mix and nonresponse on CAHPS hospital survey scores. Health Services, 44(2p), 501-518. http://dx.doi.org/10.1111/j.1475-6773.2008.00914.x
Giordano, L. A., Elliot, M. N., Goldstein, E., Lehrman, W. G., & Spencer, P. A. (2010). Development, implementation, and public reporting of HCAHPS survey. Empirical Research, 67(1), 27-37.
Goldstein, E., Marybeth, F., Crofton, C., Darby, C., & Garfinkel, S. (2005). Measuring hospital care from the patients’ perspective: An overview of the CAHPS hospital survey development process. Health Service Research, 40(6p2), 1977-1995.
Petrullo, K. A., Lamar, S., Otti-Nwankwo, O., Mills-Alexander, K., & Viola, D. (2013). The patient satisfaction survey: What does it mean to your bottom line? Journal of Hospital Administration, 2(2). http://dx.doi.org/10.5430/jha.v2n2p1
Articles on Creating Medication Tool
Hayes, K. S. (1998). Randomized trial of Geragogy-Based medication instruction in the emergency department. Nursing Research, 47(4), 211-218.
Hayes, K. (2005).Designing written medication instructions: Effective ways to help older adults self-medicate. Journal of Gerontological Nursing, 31(5), 5-10.
Lee,J,K.,Grace,K,A.,& Taylor,A,J.(2006). Effects of a pharmacy care program care program on medication adherence and persistence, blood pressure, and low-density lipoprotein cholesterol: A randomized controlled trial.JAMA, 296, 2563-71.
Morrow, D., Carver, L. M., Leirer, V. O., & Tanke, E. D. (2000). Medication schemas and memory for automated telephone messages. Human Factors, 42(4), 523-40.
Morrow, D. G., Weiner, M., Young, J., Steinley, D., Deer, M., & Murray, M. D. (2005). Improving medication knowledge among older adults with heart failure: A patient-centered approach to instruction design. The Gerontologist, 45(4), 545-552. http://dx.doi.org/10.1093/geront/45.4.545
Stenocypher, K. (2009). Creating a patient education tool. Journal of Continuing Education in Nursing, 40(10), 462-467. http://dx.doi.org/10.3928100220124-20090923-06
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George, G., Elliott, R. A., & Stewart, D. C. (2008). A systematic review of interventions to improve medication taking in elderly patients prescribed multiple medications. Drugs and Aging, 25(4), 307-324.
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Petrullo, K. A., Lamar, S., Otti-Nwankwo, O., Mills-Alexander, K., & Viola, D. (2013). The patient satisfaction survey: What does it mean to your bottom line? Journal of Hospital Administration, 2(2). http://dx.doi.org/10.5430/jha.v2n2p1
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