Background: Transitions of care are a vulnerable period for patients, during which misunderstandings about their conditions, care plans, and the purposes of prescribed medications lead to poor adherence. NYCHHC serves a minority population with low health literacy, high comorbidity burden, and socioeconomic challenges, including low income and limited educational attainment, with up to 70% of patients not completing high school. We recognized this gap and seized the opportunity to improve patient outcomes by developing a method to specifically address the complexity of medication regimens and overcome barriers to effective patient communication at discharge.
Methods: A multidisciplinary team involving Physicians, Nurses, Pharmacists, Clerical Staff, and Interpreters developed a standardized workflow and monthly education strategies for implementing a discharge script. This included a training video illustrating the process and providing medication bags for patients to ensure safe organization on discharge. Visual and verbal physician and nursing team education emphasized the importance of joint discussion at the bedside, covering reasons for a patient’s admission, their hospital course, follow-up appointments, and any changes made to medication regimens. A set of cards was created as teaching tools for the 100 most commonly prescribed medications, identified according to medication reconciliation data tailored to each unit’s prior discharges. Each card featured images of medications along with brief descriptions of their use, dosages, and potential side effects written in simple language with visual aids. Prescribed medications were linked to their indications, and nurses used the cards to guide discharge discussions, ensuring that patients understood the purpose and proper use of each medication. Assigned staff assessed patient satisfaction and understanding through 72-hour post-discharge calls as well as pre- and post-discharge surveys within 30 days following discharge.
Results: Patient experience metrics showed understanding of their health improved from 32% to 47.8%. Communication about medication indications improved from 70% to 75%, and understanding of side effects improved from 27% to 57%. Over 80% of patients could identify the purpose and use of their medications, highlighting the cards’ utility for patients with chronic conditions, low health literacy, and polypharmacy. Feedback from patients and staff was overwhelmingly positive, with nurses and physicians noticing that the cards made discharge discussions more effective.
Conclusions: Incorporating visual medication cards into the discharge process effectively improved patient understanding, adherence, and overall satisfaction. In addressing key questions related to discharge instruction, medication explanations, follow-up care, and patient understanding, improving overall communication and satisfaction. The 100% increase in HCAP score is a testament to the success of this intervention. Addressing health literacy challenges, this initiative underscores the importance of clear, visual communication and reinforces the value of a multidisciplinary approach to enhancing transitions of care and improving clinical outcomes.
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