Background: Discharge from an in-patient hospital stay is a critical opportunity to teach patients about their medications. Communication about medications and appropriate transition of care are two domains of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey via which patients evaluate hospitals. Communication about new medications and side effects is one of the domains in which hospitals score lowest, presenting an important opportunity for improvement in provider-patient teaching prior to discharge.
Purpose: To pilot an intervention that promotes iterative medication teaching throughout the in-patient stay and is memorable to patients. The intervention ought to make patients and their caregivers active participants in managing their medications by being interactive and patient-friendly. Consistent, specific medication teaching reinforced throughout the stay and integrated into existing workflows was preferred to a separate teaching session at discharge.
Description: Sixty-nine patients on a General Medical/Surgical floor of a 613-bed academic medical center were enrolled into control (n = 39) or intervention (n = 30) arms. The intervention group received a one-page planner and information about medications commonly prescribed in the hospital and their side effects. This handout was provided at or shortly after admission and patients and nurses alike were encouraged to use it to discuss new medications. All patients or their caregiver were surveyed at discharge to assess their recall of new medications and associated side effects, as well as their confidence in managing new medications, activities of daily living, and other health needs after discharge. The intervention group more often recalled multiple new medications prescribed during the visit than the control group did (77% vs. 49%, p = 0.18). They also had statistically significant improvement in recall of multiple side effects of new medications compared to the control group (47% vs. 13%, p = 0.02). When asked about how they plan to manage medications after leaving the hospital, patients in the intervention group provided more specific plans than those in the control group; for example, sharing details such as setting daily reminders or having a system for filling their pill box (97% vs. 79%, p = 0.01). The intervention group also had higher confidence in managing medications after discharge, with more patients noting they felt “very confident” (93% vs. 58%, p = 0.001).
Conclusions: Engaging patients in their medication regimen via interactive written materials can improve their recall of medications and side effects and their confidence in managing medications after discharge. Initiating this discussion during the admission rather than at discharge may make the education more effective and inculcate active participation. A shared document that both physicians and nursing staff can interact with when educating patients is important to facilitating better communication between patients and providers.