Med Effects Scripting and HCAHPS Scores
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1 Lehigh Valley Health Network LVHN Scholarly Works Patient Care Services / Nursing Med Effects Scripting and HCAHPS Scores Jacklyn Gibat BSN, RN Lehigh Valley Health Network Madelyn Glick BSN, RN Lehigh Valley Health Network, madelyn.glick@lvhn.org Follow this and additional works at: Part of the Nursing Commons Published In/Presented At Gibat, J., Glick, M. (2014, July 18). Med Effects Scripting and HCAHPS Scores. Poster presented at LVHN UHC/AACN Nurse Residency Program Graduation, Lehigh Valley Health Network, Allentown, PA. This Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by an authorized administrator. For more information, please contact LibraryServices@lvhn.org.
2 MED EFFECTS SCRIPTING & HCAHPS SCORES Jacklyn Gibat, BSN, RN Madelyn Glick, BSN, RN
3 Background Agency for Healthcare Research and Quality (AHRQ) and Centers for Medicare & Medicaid Services (CMS) developed and implemented the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS): To measure and compare data on patient s perspective of care across hospitals nationwide To create incentives for hospitals to improve quality of care To enhance public accountability by increasing the transparency of the quality of care a hospital provides
4 Significance Importance of medication teaching: To assist patients in taking an active part in their care To provide patients with a greater sense of control over the medications prescribed to them To reinforce importance and side effects of medications as a preventative health strategy
5 Purpose Medication education compliance by RN staff as demonstrated by: Patient response to individual interviews during stay Improvement in patient satisfaction as demonstrated by: HCAHPS results
6 PICO Question: PICO QUESTION P: For adult patients discharged from an acute care medical-surgical unit I: will standardized medication scripting by nurses triggered by visual cues on the kardex C: In comparison to previous practice O: Positively impact HCAHPS scores regarding new medication side effects
7 HCAHPS Questions Question 15: During this hospital stay, were you given any medicine that you had not taken before? Question 16: Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? Question 17: Before giving you any new medicine, how often did hospital staff describe possible side effects in a way that you could understand?
8 Triggers Problem-Focused Triggers 1. Risk-management data 2. Process improvement data 3. Internal/external benchmarking data 4. Financial data 5. Identification of clinical problem Knowledge-Focused Triggers 1. New research or other literature 2. National agencies or organizational standards and guidelines 3. Philosophies of care 4. Questions from institutional standards committee
9 Baseline HCAHPS Data 6C Sept- 13 Oct-13 Nov-13 Dec-13 Jan-14 *Feb- 14 Mar- 14 n= Average % Explain Meds Side Effects n= Number of patient s surveyed Target HCAHPS score of 60.89% *Unit education and dissemination began Press Ganey ( )
10 Evidence Database search: Ovid Medline (11 articles), PubMed (1 article), Google Scholar (1 article), and EBSCO Medline (1 article) Keywords: HCAHPS, medication education, scripting, patient satisfaction, peer coaches, medication management, and medication side effects education
11 Evidence Patient Perspective 25% of patients said their physician never told them about a new medication Only 10% said their physician discussed the side effects Physician Perspective 100% of physicians said they told their patients about new medicines 81% said they explained the side effects Archives of Internal Medicine, 2010
12 Evidence Inpatient postpartum unit Population: All postpartum patient s returning patient satisfaction surveys from November 2009-November 2010 Intervention: Developed unit specific medication list for patient education and enhanced nurse-to-nurse communication Outcome: HCAHPS score in medication domain increased from 59% to 71% Rovel, Bradle, & Kruesi, 2012
13 Evidence Joint replacement center at Maine Medical Center Intervention: Educational booklet placed in each patient s room for easy accessibility to nurses Outcome: Increase in patient satisfaction scores for the question, Did the nurse explain the side effects of any new medications? 23% to 53% Grant, 2012
14 Evidence Neuro-Medical Surgical tertiary care facility Population: Random chart audit of 23 patients with average length of stay of 2.7 days and Glasgow Coma Scale of Intervention: Patient informational handouts Nurse education Unit flyers Always Ask Outcome: Average score 77.3% (compared to 29% before the program) Ahrens & Winges, 2013
15 Current Practice at LVHN Review medications to be given with patients and any site requirements Teach patients about their medications during administration Name(s) of medications(s) Action and side effects of medication Self-administration of medication Medication teaching resources given to patient, if available Document teaching on interdisciplinary record in Krames
16 Practice Change Standardized medication side effects teaching by: Visual cueing Scripting Teaching at bedside during routine care and report
17 Implementation PHASE I: Engage unit champions and leadership via Unit councils Staff meetings Staff development PHASE II: Standardization of kardex and scripting processes Staff education re: new process, scripting Celebrate launch: Visual displays Staff meetings Reinforcement by EBP and Leadership teams Identify rewards/recognitions
18 New Medication Ordered M in the Box Process RN writes new medication on Kardex RN Prints Micromedex Notes Explain med and side effects to patient & document in Krames Write M in the box Strike Thru M in the box Until Teachback a Success Continue education, scripting Scripting: RN to RN, RN to Patient, Repeat
19 M in the Box Kardex Label M indicates education has been completed In figure to right: Patient has been educated on actions and side effects of Heparin and Percocet Patient has demonstrated knowledge of Percocet Side effects via Teachback M M Heparin Lasix Percocet Ancef
20 Standardized Scripting During care transactions and bedside shift report: Do you remember the name of the new medication you were given? Can you tell me why you are taking this medication? Can you tell me a side effect of this medication?
21 Expected Outcomes Increased staff compliance as demonstrated by: Documentation in Krames Repetitive educational encounters for patients Increased education reported by patients as demonstrated by: Patient interviews Increased HCAHPS scores for questions #15-17
22 Implications for LVHN Utilize scripting to educate patient while administering medication and at hand-off Provide educational materials and educate patient or family at every opportunity Utilize standardized scripting during multiple care transactions
23 Evaluation Data collected weekly by interviewing 10 patients per week Were you given any medicine that you had not taken before during this admission? Before giving you any new medicine, did hospital staff tell you what the medicine was for and possible side effects?
24 Results Process Measures: Patient Interviews April-14 May-14 June-14 July-14 n= Medicine Explain Meds 45% 55% 78% 75% Side Effects 30% 45% 60% 62% Krames 30% 30% 43% 38% n=number of patient s surveyed
25 Results HCAHPS Results April-14 May-14 June-14 n= Medicine Explain Meds 75% 66.7% 50% Side Effects 75% 66.7% 0% Average % 75% 66.7% 25.0% n=number of patient s surveyed Press Ganey ( )
26 Lessons Learned Persistent Barriers Staff Noncompliance Staff perception of increased workload Limit interaction focus to one major side effect per medication Increased patient understanding and decreased patient anxiety
27 Strategic Dissemination of Results February 2014 Disperse TLC education to Float Nurse Committee Chair March 2014 Midpoint Presentation to UHC Residency participants and facilitators July 2014 Final Presentation to UHC Residency & organizational leadership July 2014-December 2014 Ongoing peer review and support on 6C
28 Moving Forward Compare results to other pilot interventions 4C: Visual cues on communication boards 7T Muhlenberg: Pharmacy teaching tool Integrate best practices from other units into 6C medication education protocol Continue data collection and analysis July 2014-December 2014
29 References Ahrens, S. L. & Winges, A. M. (2013). Using evidence to improve satisfaction with medication side-effects education on a Neuro-Medical Surgical Unit. Journal of Neuroscience Nursing, 45(5), doi: /JNN.0b013e31829d8ca5 Bulut, H., Tanrikulu, G., Dal, U., & Kapucu, S. (2013). How much do ED patients know about medication prescribed for them on discharge? A pilot study in Turkey. Journal of Emergency Nursing, 39(3), e27-e32 Grant, B. (2012). Improving patient satisfaction through medication education. Nursing, 42(3), doi: /01.NURSE f3 Huebner, M., Temple-Cooper, M. E., Lagzdins, M., & Yeh, J. (2013). A pilot study evaluating the effect of daily education by a pharmacist on medication related HCAHPS scores and medication reconciliation satisfaction. Biosafety & Health Education, 1(2), 1-6. doi: / Kennedy, B., Craig, J. B., Wetsel, M., Reimels, E., & Wright, J. (2013). Three nursing interventions impact on HCAHPS scores. Journal of Nursing Care Quality, 28(4), doi: /ncq.0b013e31828b494c Nurit, P., Bella, B. C., Gila, E., & Revital, Z. (2009). Evaluation of a nursing intervention project to promote patient medication education. Journal of Clinical Nursing, 18(17), doi: /j x
30 References Panzarella, M., Jordan, M., & Davidson, C. (n.d.). Medication Administration. Patient Care Manual Press Ganey (2013). Inpatient report: Lehigh Valley Hospital Cedar Crest. Rovell, K. M., Bradle, J. B., & Kruesi, K. (2012). Implementation of targeted medication education for improved patient satisfaction. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 41, S119-S162 Russ, S. A., Hanna, D., DesGeorges, J., & Forsman, I. (2010). Improving follow-up to newborn hearing screening: A learning-collaborative experience. Pediatrics, 126, S59-S70. doi: /peds K Tarn, D. M., Heritage, J., Paterniti, D. A., Hays. R. D., Kravitz, R. L., Wenger, N. S. (2006). Physician communication when prescribing new medications. Archives of Internal Medicine, 166(17), doi: /archinte Zadvinskis, I., Glasgow, G., & Salsbury, S. (2011). Developing unit-focused peer coaches for the clinical setting. Journal of Continuing Education in Nursing, 42(6), doi: / Ahrens, S. L. & Winges, A. M. (2013). Using evidence to improve satisfaction with medication side-effects education on a Neuro-Medical Surgical Unit. Journal of Neuroscience Nursing, 45(5), doi: /JNN.0b013e31829d8ca5
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