Background: Many hospitalized patients have difficulty understanding what their care team tells them about medications and how to comply with medications. Communication failures about medications can have devastating consequences for hospitalized patients. Patients who report good physician communication, clear directions about how to take their medications, and more medication information are more compliant with their medications.
Purpose: To develop an interdisciplinary intervention to promote best practice communication about medications and improve patient understanding of the purpose of their medications.
Description: A Unit Based Leadership Team (UBLT) comprised of nurses, case managers, physicians, and quality improvement specialists on three Medicine units at a large academic medical center utilized a multifactorial approach to improve communication with patients about new medications. The UBLT used lean management tools to define the problem, identify current and target conditions, perform gap analysis, conduct countermeasures, and implement an action plan. The UBLT trained 100% of the nurses on all units (n=201) to write down new medications and indications on a placard. New medications were then discussed with patients and teach-back technique utilized to ensure understanding. Placards were posted in every room on a wall visible to the patient throughout their hospitalization. Charge nurses audited placards for new medication communication on a weekly basis from October 2016 through June 2017. In addition, Post-Baccalaureate students were recruited to observe teams during rounds for specific medication-related communication behaviors from February 2017 through April 2017. After rounds, students conducted follow-up interviews with patients (n=143) about their understanding of any new medications and indications and sent same-day communication observations and survey feedback to the patients’ team.
By June 30, 2017, our performance on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey question on the communication about new medications question improved. The combined HCAHPS Top Box score rose from 70% to 76%, our greatest increase on record over a fiscal year.
Conclusions: Using a multi-disciplinary approach involving patient, physician and nursing focused interventions, we were able to improve patient ratings of provider communication about new medications. Further work is needed to assess whether improved patient understanding of medications leads to increased compliance of medications and better health outcomes.