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Med Effects Scripting and HCAHPS ScoresJacklyn Gibat BSN, RNLehigh Valley Health Network

Madelyn Glick BSN, RNLehigh Valley Health Network, madelyn.glick@lvhn.org

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Published In/Presented AtGibat, J., Glick, M. (2014, July 18). Med Effects Scripting and HCAHPS Scores. Poster presented at LVHN UHC/AACN NurseResidency Program Graduation, Lehigh Valley Health Network, Allentown, PA.

MED EFFECTS SCRIPTING & HCAHPS SCORES Jacklyn Gibat, BSN, RN

Madelyn Glick, BSN, RN

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

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

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

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

▪ PICO Question:

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?

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

Baseline HCAHPS Data 6C

Press Ganey (2013-2014)

▪ n= Number of patient’s surveyed

▪ Target HCAHPS score of 60.89%

▪ *Unit education and dissemination began

Sept-

13

Oct-13 Nov-13 Dec-13 Jan-14 *Feb-

14

Mar-

14

n= 8 9 3 6 8 3 13

Average % 50.0 75.0 0.0 50.0 75.0 50.0 40.0

Explain

Meds

57.1 100.0 0.0 40.0 100.0 66.7 83.3

Side Effects 42.9 50.0 0.0 60.0 50.0 33.3 40.0

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

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

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

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

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 11-15

▪ Intervention: • Patient informational handouts

• Nurse education

• Unit flyers “Always Ask”

▪ Outcome: • Average score 77.3% (compared to 29% before the

program)

Ahrens & Winges, 2013

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

Practice Change

▪Standardized medication side effects teaching by:

•Visual cueing

•Scripting

•Teaching at bedside during routine care and report

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

“M in the Box” Process

RN writes

new

medication on

Kardex

Explain med

and side

effects to

patient &

document in

Krames

…Until

Teachback

a Success

Write

M in

the box

Continue

education,

scripting…

RN Prints

Micromedex

Notes

Scripting:

“RN to

RN,”

“RN to

Patient,”

Repeat…

Strike

Thru “M”

in the box

New

Medication

Ordered

“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

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?”

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

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

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?

Results

April-14 May-14 June-14 July-14

n= 20 40 28 8

Medicine

Explain Meds 45% 55% 78% 75%

Side Effects 30% 45% 60% 62%

Krames 30% 30% 43% 38%

• Process Measures: Patient Interviews

n=Number of patient’s surveyed

Results

▪ HCAHPS Results

n=Number of patient’s surveyed Press Ganey (2013-2014)

April-14 May-14 June-14

n= 5 6 3

Medicine

Explain Meds 75% 66.7% 50%

Side Effects 75% 66.7% 0%

Average % 75% 66.7% 25.0%

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

■ 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

Strategic Dissemination of Results

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

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), 281-287. doi: 10.1097/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), 12-14. doi: 10.1097/01.NURSE.0000411418.98785.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:10.4172/2332-0893.10

▪ 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), 327-334. doi:10.1097/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), 2530-2536. doi: 10.1111/j.1365-2702.2009.02844.x

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: 10.1542/peds.2010-0354K

▪ 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), 1855-1862. doi: 10.1001/archinte.166.17.1855

▪ Zadvinskis, I., Glasgow, G., & Salsbury, S. (2011). Developing unit-focused peer coaches for the clinical setting. Journal of Continuing Education in Nursing, 42(6), 260-269. doi:10.3928/00220124-20110215-02

▪ 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), 281-287. doi: 10.1097/JNN.0b013e31829d8ca5

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