Enhanced Patient-Safety Intervention To Optimize Medication Education (EPITOME)

Carl Sirio, MD Professor

Critical Care Medicine, Medicine and Pharmacy and Therapeutics University of Pittsburgh

Schools of Medicine and Pharmacy

AHRQ 2007 Annual Conference…Implementing Medication Safety Tools at Critical Junctures

What Are We Trying to Accomplish?

Specifically:

Increase patients’ perception of (satisfaction with) the delivery of medication education while in the hospital

Simplify medication regimens as appropriate Decrease hospital readmissions

Our aim was to develop a collaborative management approach by pharmacists, nurses, and respiratory therapists to provide standardized patient education on medication use.

AHRQ 2007 Annual Conference…Implementing Medication Safety Tools at Critical Junctures

Objectives

Describe the safety problem EPITOME description

Conceptual framework Pilot results Implementation of “education for all” Outcomes of interest

Lessons learned Successes Barriers and challenges Pending results/next steps

AHRQ 2007 Annual Conference…Implementing Medication Safety Tools at Critical Junctures

Defining the Safety Problem

11% of all hospital admissions are due to medication complications Dunbar-Jacob 2001

Inadequate patient medication education is a common reason for non-adherent behaviors and is an independent risk factor for unplanned 30-day hospital readmission

Haynes 2004, Marcantonio 1999

U.S. and Canadian studies have documented inconsistencies in the medication education component of hospital discharge resulting in poor patient knowledge of their medications

Alibhai 1999, King 1998, Cortis 1996

Barriers to hospital-based medication education by pharmacists include lack of time, no organized or systematic program for education, and inadequate discharge notification

Griffith 1998

AHRQ 2007 Annual Conference…Implementing Medication Safety Tools at Critical Junctures

The Safety Problem

Medication adherence – “the extent to which a patient’s behavior is consistent with health care recommendations.”

Pilot results Multidisciplinary education and consultation

improved: Specific medication knowledge

AHRQ 2007 Annual Conference…Implementing Medication Safety Tools at Critical Junctures

Specific Knowledge About Medication

57.7%

38.7%

76.7%

65.1%

0%

20%

40%

60%

80%

100%

Control Uni t Intervention Uni t

pre post

AHRQ 2007 Annual Conference…Implementing Medication Safety Tools at Critical Junctures

The Safety Problem

Medication adherence – “the extent to which a patient’s behavior is consistent with health care recommendations.”

Pilot results Multidisciplinary education and consultation

improved: Specific medication knowledge Satisfaction with medication use education

AHRQ 2007 Annual Conference…Implementing Medication Safety Tools at Critical Junctures

Global Satisfaction with Medication Education

70.1%63.5%55.8%

84.4%

0%

20%

40%

60%

80%

100%

Control Unit Intervention Unit

pre post

AHRQ 2007 Annual Conference…Implementing Medication Safety Tools at Critical Junctures

The Safety Problem

Medication adherence – “the extent to which a patient’s behavior is consistent with health care recommendations.”

Pilot results Multidisciplinary education and consultation

improved: Specific medication knowledge Satisfaction with medication use

education Self reported adherence

AHRQ 2007 Annual Conference…Implementing Medication Safety Tools at Critical Junctures

Patients are not

receiving adequate

medication education

before leaving the

hospital

Hard to predict LOS

High patient acuity and number of

medications

Inconsistent knowledge of resources

Inconsistent availability of

teaching tools

Patient

Health Care Team

Resources

Methods

Staffing Shortages

Little collaboration amongst disciplinesPatient education

left to day of discharge

Variability in the degree/amount of education

High census and patient turnoverGeneric teaching

documentation forms

The Safety Problem

AHRQ 2007 Annual Conference…Implementing Medication Safety Tools at Critical Junctures

The Intervention - EPITOME

Conceptual framework There are three basic tools of medicine…”the

herb, the knife and the word.” Health behavior change model

Educate – rapport, verbal/written Reinforce – comprehension, consult Evaluate - barriers

AHRQ 2007 Annual Conference…Implementing Medication Safety Tools at Critical Junctures

EPITOME

Patient needs assessment of: Oral medications

Routine patient needs Complex medication regimens

Pharmacist consultation

AHRQ 2007 Annual Conference…Implementing Medication Safety Tools at Critical Junctures

EPITOME

Education for “all patients” Timing Exclusion Surrogates

Multidisciplinary approach Medicine Nursing

AHRQ 2007 Annual Conference…Implementing Medication Safety Tools at Critical Junctures

Define the role of everyone within EPITOME

Role of the Nurse/Nursing Unit Give patients a medication education folder upon admission Print Medication Education leaflets with each new medication and give

them to the patient Educate EVERY patient on their medications at each medication

administration Review the following throughout the hospital admission utilizing the

health behavior change model: Medication name and indication How to take it (number of times per day) Any special administration instructions (take with food) Common side effects

Document Medication Education every day

AHRQ 2007 Annual Conference…Implementing Medication Safety Tools at Critical Junctures

EPITOME

Education for “all patients” Timing Exclusion Surrogates

Multidisciplinary approach Medicine Nursing Pharmacy

AHRQ 2007 Annual Conference…Implementing Medication Safety Tools at Critical Junctures

Define the role of everyone within EPITOME

Role of the Pharmacist Educate patients ordered 10 or more oral medications Educate patients identified by the nursing staff who need

additional education Review the following utilizing the health behavior change model:

Medication name and indication How to take it (number of times per day) Any special administration instructions (take with food) Common side effects

Document Medication Education and provide medication management modifications within the Progress Note Section of the patient chart

AHRQ 2007 Annual Conference…Implementing Medication Safety Tools at Critical Junctures

EPITOME

Education for “all patients” Timing Exclusion Surrogates

Multidisciplinary approach Medicine Nursing Pharmacy Respiratory Therapy

AHRQ 2007 Annual Conference…Implementing Medication Safety Tools at Critical Junctures

Define the role of everyone within EPITOME

Role of the Respiratory Therapist Educate all patients on an inhaled medication at each medication

administration Review the following throughout the hospital admission

utilizing the health behavior change model: Medication name and indication How to take it (number of times per day) Any special administration instructions (take with food) Common side effects

Document Medication Education within the respiratory treatment log form available on the patient clipboard

AHRQ 2007 Annual Conference…Implementing Medication Safety Tools at Critical Junctures

EPITOME

Training & staffing Patient materials

Links to HIT Medical record documentation Auditing implementation performance

Trouble shooting Rapid sequence performance improvement

efforts

AHRQ 2007 Annual Conference…Implementing Medication Safety Tools at Critical Junctures

EPITOME

Outcomes assessment Patient satisfaction and awareness

AHRQ 2007 Annual Conference…Implementing Medication Safety Tools at Critical Junctures

Mean Patient Response 1.0 (Never)-5.0 (Very Often)

0

1

2

3

4

5

Nov'05

Dec'05

Jan'06

Feb'06

Mar'06

Apr'06

May'06

Jun'06

Jul'06

Aug'06

Sep'06

Oct'06

Nov'06

Dec'06

Jan'07

Patients’ Perception of (satisfaction with) the Delivery of Medication Education While in the Hospital

Threshold=4

AHRQ 2007 Annual Conference…Implementing Medication Safety Tools at Critical Junctures

EPITOME

Outcomes assessment Patient satisfaction and awareness Medication error identification and prevention Complexity of medication regimen

(simplification) Hospital readmission

AHRQ 2007 Annual Conference…Implementing Medication Safety Tools at Critical Junctures

EPITOME – Lessons Learned

Successes Pharmacist interventions and consultations Respiratory Therapy teaching Patient awareness of their medications

Under assessment Simplification of complex medication regimens Hospital readmissions

AHRQ 2007 Annual Conference…Implementing Medication Safety Tools at Critical Junctures

EPITOME – Lessons Learned

Barriers Nursing workflow and teaching:

“shifting the cultural paradigm” from teaching at discharge to teaching over time – “titration and dosing” of educational efforts

HIT barriers Producing useful educational materials for the

bedside The “information quality” issue

AHRQ 2007 Annual Conference…Implementing Medication Safety Tools at Critical Junctures

Dissemination Steps

What worked What needs to be improved