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Patient education regarding the purpose and side effects of medications can be important to ensuring adherence and optimizing patient outcomes. However, it can be difficult for patients to absorb this information while experiencing an episode of acute illness, especially given the anxiety that can accompany a frightening diagnosis such as cancer. Margaret Highley, MSN, RN, OCN®, and members of the surgical oncology unit at The James Cancer Hospital and Solove Research Institute at The Ohio State University Wexner Medical Center in Columbus, Ohio, undertook an interdisciplinary quality improvement process to eliminate barriers to thorough patient education regarding medications prior to discharge. At the Oncology Nursing Society (ONS) 44th Annual Congress in Anaheim, California, i3 Health spoke with Ms. Highley and with Rebecca Grimmett, RN, OCN®, who was also involved in the project's implementation, about the quality improvement process and key takeaways from its results.
What was the issue that led you to undertake this project?
Margaret Highley, MSN, RN, OCN®: We were looking at ways to improve our unit-based HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) scores, or patient satisfaction scores. We saw that our patients were not feeling like they had a great understanding of the side effects and the purpose of their medications at discharge. On a surgical oncology unit, where patients often go home on blood thinners, insulin, or other high-risk medications, that was something for which we immediately decided to come up with an inventive solution that would make a truly meaningful change for our patients.
Rebecca Grimmett, RN, OCN®: Increasing patients' understanding of their medications at discharge increases their outcomes at home as well. The better educated they are in the hospitals, the better they can take care of themselves at home. It decreases the return visits, and it also increases their compliance with their medications, their follow-ups, and how they care for themselves.
Can you describe your approach?
Ms. Highley: One of the tenants of ONS and of the ONS conference is that we're looking for nursing innovation. Funnily enough, our innovation for this project was primarily that we asked our patients what they wanted, which I think is something that can often get missed. It doesn't get missed intentionally, but because we're always looking for evidence-based methods to educate our patients, sometimes we forget that we need to ask people what they want.
Once we surveyed patients, what we learned is that nearly half of patients are looking for reading material, but they also want to discuss it with a health care member. They're looking for that connection, to go over that material and have some verbal confirmation that they understand it.
Then the other half of patients either want it only verbally or only in writing, which is also really interesting to me. People are different in terms of their learning styles; they absorb things in different ways. I know that I'm very visual, but I would still want to have a nurse to go over the material with me, so I understand both sides.
So we looked at our staffing model—as a surgical oncology unit, we have nurses, we have our patient care associates (PCAs), and then we have unit clerks—and we wanted to find a way to utilize all the members of our team.
The process we designed starts with the unit clerks. They print out copies of all of our most commonly used discharge medications for the nurses to go over with the patients. We also use tablets that we are fortunate to have that interface with our electronic medical record; we have the unit clerks provide those tablets to the patients. Our PCAs are also able to do this, and they help coach the patients on how to use the tablets.
Then our nurses are able to go in and do that medication education on a daily basis. What we have seen is that when a nurse educates a patient on at least one discharge med a day, the nurse can also reinforce what the patient learned the day before.
Ms. Grimmett: The patients have told me that as a result of this process, they feel a lot more comfortable with their medications. Maybe they've been on these medications for months or years at home and they never actually understood the medication, its primary use, or its side effects. They say, "Well, the pharmacist asked if I had questions, but I didn't know enough about the medication to ask a question." So when you go over everything, saying this is the medication, this is what it is for, this is how it works, and these are the side effects that we need to monitor for, then they have a much better picture of the medication and how it works for them.
I've had patients say, "I've taken this for several years, and I did not know this; I learned all this in one day," so the tablets and the medication education project have been excellent.
Especially when a patient doesn't even know what a medication is for, this education must be extremely useful for them.
Ms. Grimmett: Yes, because they'll say, "Well, I think the doctor gave that one to me for my heart." Well, actually this one here is a diuretic, so what that's going to do is increase your urine output. It does affect your heart, but it's not a heart medication. That's how our tablet system and the medication education have really benefited our patients. Not only do they know what the medication is, but they also know what it's being used for with them, since medications can of course be used for different things.
What are some of your takeaways regarding the most effective ways to educate patients?
Ms. Highley: I think that the most important thing in nursing in general is meeting the patients where they're at. It's the on-the-spot conversation that the nurse has with their patients that enables the nurse to get a true sense of what patients already know and what they need to know. Even though we have this technology and we have this process for making sure that we're teaching patients in the way in which they want to learn, that doesn't replace the nurse-to-patient connection. Not only does having that relationship help medication teaching, but medication teaching helps that relationship. It's a really great symbiotic sort of thing.
I would say that the most effective education continues to be patient specific. Some patients do a great job of utilizing the patient portal, which is available on the tablet, and that's how they want to learn, but we have the other half of patients that want to have everything on paper so that they can take it home. We give them a folder that has all their medication and discharge teaching in it. That's where that nurse relationship comes in: in knowing what the patient's preferences are.
Ms. Grimmett: I think that empowering the patient with knowledge is the biggest thing that I have taken away from the project. They feel like, "Oh, I know what this is. I can do this."
Is there anything in particular that it took to implement this program as a whole that other organizations would need to keep in mind? It must have been quite a coordination effort, right?
Ms. Highley: That's kind of a funny thing, because when you think about it, yes it's a process—it involves technology—but it's really pretty simple. It's knowing your unit, knowing your patient population, knowing the 15 most common meds that patients have at discharge—knowing what monster you're facing.
In addition, we've engaged our physicians in this process. Some of our attending physicians are very, very invested in this, and they're also doing a good job of rounding on the patient and making sure that they understand the medications as well. It is important to involve as many members of the health care team as you can, like we did with the unit clerks, the PCAs, the nurses, and the physicians: the more people that you can get on board and get to understand the importance of the process, the better.
Ms. Grimmett: And I think the big thing is that if we didn't have excellent management on our floor, we would not be able to implement these new processes. It does take a lot of coordination on their end as well, and it is essential that management supports these efforts and continues with all of the initiatives. We have new initiatives practically every month because we want to be the best. Our goal on our floor is to be the best floor in The James. We try to be very innovative; they work very hard to come up with things, and we address every single issue or problem that comes up.
Ms. Highley: I think that the beauty of the process is that you can do it regardless of what resources you have. It's something as simple as the unit clerk going in before the patient is admitted and putting a folder on the counter in the patient's room that already has a lot of this information in it so that as the patient is recovering from surgery, the family is in the room looking through this folder, saying, "Hey, what's this?" That doesn't even require technology—it's just the thoughtful placement of a folder in a patient's room.
And yet it's a really good idea.
Ms. Highley: Yeah, it doesn't have to be a super fancy thing; you just need to be purposeful about it.
Ms. Grimmett: Yes, even if that thing is simply asking the patient, "What is your preferred learning method? Do you want us to read this to you? Do you want to read it first, and me come back in 10 minutes, and then I'll go over questions with you?" A program can start just by putting printed papers in a folder, or you can contact an electronics manufacturer and see if they'll donate some tablets.
Is there anything else that you would like to add?
Ms. Highley: Only that we couldn't do it without the great staff that we have!
About Ms. Highley and Ms. Grimmett
Margaret Highley, MSN, RN, OCN®, is the Assistant Nurse Manager of Surgical Oncology at The James Cancer Hospital and Solove Research Institute at The Ohio State University Wexner Medical Center. Rebecca Grimmett, RN, OCN®, who also works at The James Cancer Hospital and Solove Research Institute, is a Clinical Ladder IV Staff Nurse in Surgical Oncology.Transcript edited for clarity. Any views expressed above are the speaker's own and do not necessarily represent the views of i3 Health.