Christiana Care Health System, Wilmington, DE, has implemented an interactive medication education workflow tool that increased average monthly Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores by three points (five percent) and earned accolades from clinicians, executives, patients and families.
Since the go-live in December 2009, Christiana Care has educated more than 33,000 patients and their family members about 180,000 medications.
Like many other hospitals, Christiana Care wanted to improve its medication teaching workflow to promote greater consistency, efficiency and accountability.
Although the hospital was impressed with interactive TV technology that had been installed, it still lacked a convenient, engaging bedside tool to explain medications and their side effects to patients and families.
Nurses at Christiana Care typically moved from a patient's room to a nursing unit computer, entered a drug name into the hospital's formulary dataset, printed any relevant information and returned to the patient's room to engage in medication teaching.
Depending on the number of patient medications, nurses could take anywhere from 2 to 15 minutes to retrieve the information needed.
As a recipient of Medicare funds, Christiana Care is a regular participant in HCAHPS, a national, standardized, publicly reported survey of patients' perceptions of the hospital experience.
Mediation teaching is also an essential element of the Joint Commission's National Patient Safety Goals. Specifically, under the mandate to "use medications safely," hospitals must do the following:
- Record and pass along correct information about a patient's medicines.
- Find out what medicines the patient is taking.
- Compare those medicines to new medicines given to the patient.
- Make sure the patient knows which medicines to take when they are at home.
- Tell the patient it is important to bring their up-to-date list of medicines every time they visit a doctor.
Responding to these pressures as well as an annual operating plan goal to enhance the patient experience through more complete medication education, Christiana Care's nursing and information technology leaders joined forces with a healthcare education vendor to develop a solution nurses could use in helping patients better understand their medications. Among the objectives were to:
- create more efficient staff workflow;
- boost HCAHPS scores by 8 percent;
- enhance patient and staff satisfaction;
- increase consistency in medication education;
- involve more patients in medication education;
- deliver secure access to patients' medication lists; and
- meet Joint Commission and health system patient education goals.
Installed in more than 900 patient rooms, the interactive TV-based medication information system interfaces with Christiana Care's electronic health record.
Timing is Everything
Patients and staff are now able to view a list of prescribed medications on their bedside monitor once medications are profiled and verifieid by the pharmacy.
To protect the patient's privacy, patients and staff members are required to provide a password to access the information. If a patient is transferred to another unit, the list of medications follows.
Medications are listed by generic names, followed by brand names in parentheses.
Additionally, they are grouped as "Medications I Take Regularly" and "Medications I Take as Needed" with high-alert medications identified with an exclamation mark and moved to the top of the list.
If patients and staff need to know more about a specific drug, they can access a detailed medication page which provides information on the medication including side effects and special precautions.
Once patients review a medication information page for the first time, they become eligible to choose a free movie as an incentive.
Patients also have access to 33 medication videos which are automatically ordered for the patient and displayed on their personalized video list.
Patients also benefit from timely e-alerts. They receive an alert when a new medication is profiled and verified by the pharmacy and, if a medication is discontinued, patients are alerted to the change, the medication is designated "discontinued" on the medication list and the medication will drop off their list within 24 hours.
Element of Satisfaction
The hospital informs patients of the interactive medication system on admission as part of their complete picture of the patient's diagnosis and treatment, including medications.
This is especially critical when the patient is severely ill or mentally disabled. The goal is to encourage patients and families to interact with the bedside system and participate in their own care with the aim of accelerating the healing process.
To further ensure patient and staff satisfaction, Christiana Care leaders conduct management rounds to determine how well patients understand their medications. Among the standard questions are:
- Did staff recommend how to use your medications? (HCAHPS 16)
- Did staff explain the side effects of your medications? (HCAHPS 17)
If patients respond positively, nurses are recognized for exceptional medication teaching and awarded cafeteria vouchers, movie tickets or other prizes.
As a result of its medication teaching system, Christiana Care experienced a 14 percent increase in the top box score of the HCAHPS medication teaching category.
After just 6 months, scores on medication use teaching increased 14 percent; scores on medication side effect teaching increased 16 percent.
With feedback from nurse managers and staff, Christiana Care continues to look for creative ways to improve the patient experience.
As part of this effort, Christiana Care plans to implement the ability for inpatients to view their vital signs and blood sugar levels through a feed from the EHR.
Further down the road, the patient will have the opportunity to continue their health education after discharge through a consumer-based version of the patient education program.
Katherine Pereira-Ogan is the director of service excellence for Christiana Care Heath System, Newark, DE.