Background: The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is an instrument used to evaluate patient experience and satisfaction during patients’ hospital stay. One of the areas assessed by the survey is education about medications. The survey asks patients how often they were educated about the purpose and possible side effects of any new medications they received, and whether they understood the purpose for taking their medications upon discharge.
Purpose: The aim of this quality improvement initiative was to assess whether the use of medication cards to facilitate patient education would improve HCAHPS scores on an inpatient telemetry unit. By improving patients’ understanding of medications, particularly in a heart failure designated specialty floor where numerous new medications are introduced, it may help enforce compliance and decrease the rate of readmissions.
Description: Beginning in January 2019, medication cards for 29 commonly initiated drug classes describing medication brand and generic names, indications, common side effects, and potential serious side effects became available on the inpatient telemetry unit. Pharmacy and nursing personnel distributed the medication cards to patients who were initiated on any new medications and anyone who was thought to have potential benefit from medication education. Patient education using the cards was documented in the electronic medical record, and data was collected on the number of medication cards distributed weekly and the percentage of patients who were discharged with at least one medication card. HCAHPS survey scores were monitored to assess the impact of the quality improvement project on patient responses to questions regarding medication education during their hospital stay.From January to July 2019, over 1,000 medication cards were distributed. Twenty-nine percent of all discharges had documented receipt of at least one medication card during their hospitalization. In an anonymous nursing survey distributed in May 2019, 94 percent of nurses on the unit agreed that providing patients with medication cards was easy to incorporate into their daily workflow. HCAHPS scores for all medication related questions improved from 2018 baseline. Overall communication about medications improved from the 12th to 45th percentile. Scores for staff describing what patients’ new medicine was for increased from the 13th to 57th percentile, describing medicine side effects increased from the 13th to the 38th percentile, and patient understanding of the purpose of taking their medications on discharge from the 57th to the 66th percentile. During this time period, the telemetry unit saw a downtrend in readmissions from 142 readmissions down to 112 (January to June 2018 compared to January to June 2019). Readmissions for heart failure averaged 10% compared to the hospital average of 20%.
Conclusions: Medication cards appear to be a simple and effective tool that can be incorporated into the daily nursing and pharmacist workflow to ensure that patients are educated about new medications prior to discharge and improve patient satisfaction as indicated by the HCAHPS survey. The downtrend in readmissions since initiation of medication cards suggests the positive impact made by improving patient experience and understanding of their medications.