MHCA Annual Meeting Tasty Improvements for Management of Oral Medication Clinical Quality Team Presenters: Dawn Ekstrom, HealthEast Home Care Stephanie Keppers-Anderson, St. Luke s Home Health Services 1 Clinical Quality Team (CQT) Jan Usset, Allina Home & Community, Board Liaison, Chair Paula Berger, Integrated Home Care, Stephanie Keppers-Anderson, St. Luke s Home Health Services Dawn Ekstrom, HealthEast Home Care, Janelle Shearer, Stratis Health Nancy Millard, Crystal Care Home Health Sylvia Haroldson, Fairview Home Care and Hospice Jodi Nelson, First Care Medical Services Edel Austin, Edelweiss Home Health Care 2 Clinical Quality Team (CQT) Marty Sureth, Bayada Nurses Christine Moore, North Memorial Home Health and Hospice Beth Branz, North Memorial Home Health and Hospice Kecia Hayslett, Arms of Compassion Home Care Nichole Gruis Diekman, Fairview Red Wing Home Health Care & Hospice Jill Havlik, HealthEast Home Care Jeanne Roudabush, Covenant Care at Home Jaimi Michelson, Cottonwood-Jackson CHS Jason Czycalla, Medline Industries, Inc. 3 Medication Management 2010 1
Session Objectives Recognize the connection between process measures, patient satisfaction, and outcomes related to oral medications Identify solutions to improve oral medication outcomes Implement various tools to assist providers in improving oral medication outcomes ie. Teach back and Health literacy Compare your oral medication outcomes to the State and National results 4 Medication Management Statistics According to the Institute of Medicine s July 2006 report Preventing Medication Errors, medication errors harm an estimated 1.5 million Americans each year, resulting in upward of $3.5 billion in extra medical costs. The health of 90 million people in the U.S. may be at risk because of the difficulty some patients experience in understanding and acting upon health information. Reference: http://www.npsf.org 5 Medication Management Statistics One out of five American adults reads at the 5th grade level or below, and the average Literacy Statistics. Literacy skills are a stronger predictor of an individual s health status than age, income, employment status, education level, or racial/ethnic group. The health of 90 million people in the U.S. may be at risk because of the difficulty some patients experience in understanding and acting upon health information. Reference: http://www.npsf.org 6 Medication Management 2010 2
MN Reality: Where We Are Today How often patients got better at taking their drugs correctly by mouth? Source: Home Health Compare Website, April 2012 Information from OASIS-C January 2011 December 2011 7 MN Reality: Where We Are Today How often the home health team taught patients (or their family caregivers) about their drugs. Source: Home Health Compare Website, April 2012 Information from OASIS-C January 2011 December 2011 8 Study Results Does your agency have an Electronic Health Record? 76% Yes 24% No Is documentation completed at point of care? 53% Yes 47% No Is the majority of OASIS documentation completed when the clinician is in the patient s house? 58% Yes 42% No Are your clinicians able to view previous visit notes when in patient s home? 73% Yes 27% No Are your clinicians able to view medication lists from hospital or clinic when in patient s home? 34% Yes 66% No 9 Medication Management 2010 3
OASIS Accuracy OASIS accuracy degrades by the minute from the patient s home to the nurse s home or office Reference: HHNUG Conference 10/14/2010 presentation from Bedside to Billing presented by Tim Rowan. 10 Best Practice for Medication Management Review and Reconciliation of Client Medications Ask at every visit about medication changes review & reconciliation Medication Regimen Review At Admission At Least Every 60 Days When Medications Change Advise Client of Agency Contact Information if Issues 11 Best Practice for Medication Management Notifying MD of Medication Problems Notification for M2002 includes addressing Issues with the physician within one calendar day physician needs to respond with acknowledgment of receipt of information and/or further advice or instructions New process measure question January 1, 2010 12 Medication Management 2010 4
Why Focus on Medication Management Medication management impacts hospitalization, emergent care, OASIS OASIS items related to medications Inconsistency in client medication lists across health care settings HHCAHPS Focus on Medications Impact patient Quality of Care 13 Quality Forces Impacting Homecare CoPs: Medication Reconciliation OASIS Quality Outcome Data: OASIS Reports Patient Satisfaction (HHCAHPS) by Medicare Care Transitions: Reduce Hospitalization R/T Medication Issues National Focus -Home Care Role Health Care Reform Value Added Purchasing: Quality Outcomes for Reimbursed Care Health Care Industry looking to Home Care for Quality Outcomes 14 Quality Forces Impacting Homecare Patient Centered Care Desired by Patient/ Families Engage Client in Goal Setting & Achieving Validation for Professional Clinicians As Evidenced by Quality Outcomes Fall Prevention Strategies Reduce number of medications Management of medications R/T falls 15 Medication Management 2010 5
A program created by the Minnesota Health Literacy Partnership Reference: http://www.healthliteracymn.org/resources/presentations-andtraining 16 Teach Back Objectives Define teach-back and its purpose Describe the key elements for using teach-back correctly Use teach-back in the clinical setting Quote: George Bernard Shaw The problem with communication is the illusion that it has occurred. Reference: http://www.healthliteracymn.org/resources/presentations-andtraining 17 Teach-Back Basics What is it? Who should I use it with? When should I use it? Where should I use it? Why should I use it? How should I use it? 18 Medication Management 2010 6
Teach-Back... Asking patients to repeat in their own words what they need to know or do, in a nonshaming way. NOT a test of the patient, but of how well you explained a concept. A chance to check for understanding and, if necessary, re-teach the information. 19 Teach-Back... Who? Elderly Ethnic and racial minorities/lep Persons with limited education Persons of low socioeconomic status Persons with chronic disease 20 Teach-Back... Where? Teach-Back can be used in all clinical settings... Clinic Home Health Hospital What other clinical settings would this work in? Would this work in non-clinical settings? 21 Medication Management 2010 7
Teach-Back... When? The teach-back technique should replace the more common practice of simply asking a patient, Do you understand? Experience shows that t patients t often answer yes to such questions, even when they understand nothing. Any examples? 22 Teach-Back... Why? Teach-Back is supported by research! Asking that patients recall and restate what they have been told is one of the 11 top patient safety practices based on the strength of scientific evidence. AHRQ, 2001 Report, Making Health Care Safer Physicians application of interactive communication to assess recall or comprehension was associated with better glycemic control for diabetic patients. Schillinger, Arch Intern Med/Vo640 l 163, Jan 13, 2003, Closing the Loop 23 Teach-Back... Why? Provides an opportunity to check understanding with the patient and re-teach if necessary. Re-phrase if a patient is not able to repeat the information accurately. Ask the patient to repeat the information again, until you are comfortable they really understand it. If they still do not understand, consider other strategies (pictures, videos, analogies). Teach Back Video 24 Medication Management 2010 8
Teach-Back... How? Ask patients to demonstrate understanding What will you tell your spouse about your condition? I want to be sure I explained everything clearly, so can you please explain it back to me so I can be sure I did. Show me what you would do. Chunk and check Summarize and check for understanding throughout, don t wait until the end. Do NOT ask... Do you understand? Reference:http://www.healthliteracymn.org/resources/presentations-and-training 25 Teach-Back in Action http://www.youtube.com/watch?v=2n0gczdvfnm Additional Points... Slow down Use a caring tone of voice and attitude Use plain language Break it down into short statements Focus on the 2 or 3 most important concepts Reference:http://www.healthliteracymn.org/resources/presentations-and-training 26 Teach-Back Humor Reference:http://www.heal thliteracymn.org/resources /presentations-andtraining 27 Medication Management 2010 9
Acknowledgements The Minnesota Health Literacy Partnership would like to thank the following organizations for contributions to this training: 28 Role Play The patient has just been diagnosed with high blood pressure and will need to make serious changes to her diet (eating fewer high fat/high calorie foods and consuming less salt) and start taking medication. Mr(s). Johnson, your blood pressure over the last 4 visits has averaged 150/100 resulting in a diagnosis of hypertension. In order to treat this, you will need to take a medication called hytrin and make some substantial lifestyle changes including a low sodium diet. 29 Role Play The patient has been diagnosed with Congestive Heart Failure and will need to start nebulizer treatments and using an inhaler. Dr.: Mr(s). Smith, you have been diagnosed with Congestive Heart Failure. In order to improve your breathing you will need to use inhalers and nebulizer treatments. 30 Medication Management 2010 10
Role Play The patient has just been diagnosed with diabetes and needs to start monitoring her blood sugar levels and taking insulin. The GTT is a test that tells you how well your body is breaking down sugar. Type one diabetes means that the pancreas no longer produces insulin. DR: After reviewing your GTT results it has been determined that you have type 1 diabetes mellitus. This means that you will have to start monitoring you glucose level using a glucometer and giving yourself multiple insulin shots every day. 31 Discussion 32 Medication Management 2010 11