Interdisciplinary drug education improves outcomes for patients and reduces readmissions to the hospital

Patients with their medications and taking them according to instructions are important for improving the care and outcomes of patients with heart attacks, as well as potentially reducing preventable readmissions, according to a study presented at the ACC Quality Summit. in New Orleans.

A heart attack is usually an unplanned event that can leave patients overwhelmed by new medications, clinicians, and other additions to their health care upon discharge. When patients leave the hospital, hospital staff informs them about their medications. However, many patients have difficulty understanding and following these instructions.

A new quality improvement plan, developed by the Olathe Medical Center in Olathe, Kansas, and launched as part of the Patient Navigator program of the American College of Cardiology program: Focus MI, has shown promising results and clarified how to tackle the problem. The study group examined the patient's perspective on hospital discharge and monitoring experience when developing solutions.

"When patients leave a hospital, they often feel that the care plan for the leave is unprepared," said Tara See, RN, BSN, Olathe Medical Center and leader of the initiative. "Another complaint is that follow-up care is not well established at time of discharge, that communication with providers who receive them after hospitalization is limited, that medication reconciliation and instructions can be difficult. to understand and that expectations about their recovery and their needs are unclear. "

In April 2018, an interdisciplinary team at the Olathe Medical Center, including a registered bedside nurse, a cardiology nurse navigator, ground pharmacists and ambulatory cardiac rehabilitation staff, implemented and implemented the following communication process. on drug education:

• Once the patient is admitted, a registered bedside nurse will review any new medication with the patient, a family member, or the caregiver, including the purpose and side effects of the medication. "This can be easily done with patient drug cards that are predefined and ready for use," he said.
• Once the doctor has prescribed the discharge medications, the nurse navigator in cardiology asks the patient to write the drug information on a visual aid form called a medication diary. This includes the name of their medications, their use, their dose, their frequency and the time at which they must be taken. See "We may do this at the same time as the pharmacist's instructions during the leave or separately, depending on similar availability".
• Then, the upstairs pharmacist educates the patient in more depth about his medications, explaining potential side effects and drug interactions, the procedure to follow in case of a missed dose and then providing any other necessary instructions.
• After leaving the hospital, the care coordinator or nurse navigator calls the patient within 48 hours of his call. This call includes relearning medication, which requires the patient to read from memory or read from his medicine bottle the name and use of his medications.
• At the first outpatient cardiac rehabilitation appointment, the patient is asked to check the box corresponding to their current medications in a list of common heart medications. This helps to make sure they know their medications well.

With the help of the HCAHPS (Consumer Assessment and Hospital Health Systems) survey – satisfaction survey required by the Centers for Medicare and Medicaid Services for all US hospitals, the research group discovered that HCAHPS scores for understanding hospital medications increased by 10% between trimesters. a quarter and two in 2018 after the implementation of the program. In addition, prior to the implementation of the plan, the unadjusted readmission rate for the first quarter of 2018 was 8.2%. Since implementation, the rate for the second quarter has fallen to 3.4% and the third quarter to 3.6%.

"We recognize that improving the understanding of medicines is only part of what hospitals must do to reduce the number of readmissions," said the Secretary-General. "We also continue to focus on other goals, such as increasing risk badessment and appropriate interventions for high-risk patients, which we believe will optimize our process and reduce the risk." the number of readmissions. "