Pharmacy and Nursing Collaborate to Improve the Patient Experience Communication about Medications

Transcription

1 Learning Points 1. Explain why pharmacists are highly qualified and motivated to improve patient education on newly prescribed medications. 2. Illustrate how to create memorable education through design, content and workflow. 3. Compose teaching points that provide relevant information that does not overwhelm the audience. 4. Describe the importance of sustaining the work through dissemination to all units and hard-wired processes. Pharmacy and Nursing Collaborate to Improve the Patient Experience Communication about Medications Christine Z Dennis, PharmD, MBA Tonya Faulkner, RN, BSN, PCCN Rex Healthcare, Raleigh NC North Carolina

2 Not-for-profit Acute Care Community Hospital Founded in beds Pharmacist Colleagues Partners in Medication Education

3 Hospital Pharmacists Doctoral Degree Understand Disease States, Treatment Plans Trained to Educate Patients Provide Bedside Consultation Part of the team! Medication Cards for Patients Pharmacists Prepare Cards for Nurses to Share Medication Teaching Barriers to Success Information overload Pharmacist time and resources Nursing time and resources Nurse knowledge of side effects Patients do not recall teaching

4 Card Design KEEP IT SIMPLE Drug Names Indication Side Effects MAKE IT MEMORABLE Heavy card stock Unique size Colorful

5 Process Workflow NURSE BUY-IN Ask nurses for most used drug list Staff meeting Training HARD-WIRE Manager monitors cards given Bedside shift report reminder Method Each unit self-identified top new drugs Pharmacist created simple cards Graphic designer prepared proof Second Pharmacist approved final draft Distribution provided item numbers Printer prepared in packs of 250 cards Nurse managers set expectations, created storage boxes and taught workflow Most Used Drugs by Unit DRUGS - Generic Name Brand Name Category 3E 3W 4E 4W 5E 5W 6E acetaminophen Tylenol Pain amiodarone Cordarone antiarrhythmic aspirin Aspirin Pain x aspirin and dipyridamole Aggrenox Blood - antiplatelet agent x bisacodyl Dulcolax GI bumetanide Bumex Diuretic x calcium Acetate (Phoslo) Phoslo Antidote x cefazolin (Kefzol, Ancef) Kefzol, Ancef Antibiotic clopidigrel (Plavix) Plavix Blood - antiplatelet agent x diazepam (valium) Valium Benzodiazepine x digoxin Lanoxin antiarrythmic x x diphenhydramine Benadryl antihistamine Cardiac - Adrenergic dobutamine Dobutamine Agonist

6 Nursing Workflow Place card file in Medication Room Nurse selects card when pulling medication for administration Nursing Workflow Nurse provides verbal education before medication administration Patient keeps card in teaching folder Nurse documents on Patient Education Form in EMR Two nurses open teaching folder and review new cards given during bedside shift report PILOT PROJECT RESULTS

7 Indication PILOT STUDY Side Effects PILOT START Side Effects 23 - Before giving you any new medicine, how often did hospital staff describe possible side effects in a way you could understand? Would you say: PILOT STUDY

8 Tips for Success Engage the pharmacist team Keep cards simple Make cards memorable Garner Leadership support Obtain price quotes early Plan for card distribution Pharmacist Student Educator UNC Eshelman School of Pharmacy Campbell University School of Pharmacy Pharmacist Preceptors Unit Nurses and Manager Campbell University

9 Student Role Objectives By the end of this rotation, the student will: Confidently engage in independent bedside patient visits in the acute care setting. Gain experience working on a nursing unit as part of a multidisciplinary team. Demonstrate ability to identify physical risks to the patient, infection control concerns, and factors affecting patient or family satisfaction with care. Demonstrate ability to effectively address patient and family concerns. Understand the rationale and process of medication reconciliation; demonstrate proficiency in patient interview technique and documentation of patients home medication histories. Teach with confidence: anticoagulants, antiarrhythmics, cardiovascular agents, and enoxaparin/arixtra, including self injection technique. Teach any new medication added to the patient s regimen. Document education provided in the electronic medical record. Make recommendations regarding optimization of medication regimen and review with precepting pharmacist. Use drug information resources quickly and proficiently when asked drug information questions by patients and families. Orientation Pre-requisite: Patient Counseling Course, Pharmacy School Hospital and department orientation Bedside experience orientation with Service Excellence Team Training modules on medication education Training on EMR documentation Teaching training: anticoagulants, antiarrhythmics, and unit specific medications Shadow with pharmacist Observe leader rounding, hourly rounding, and bedside report VISIT TYPES Welcome visit Consultation requested 5+ Day, Length of Stay Discharge Education

10 New Patient Visits Morning of day #2 Introduction Symptoms review pain? nausea? appetite? Opportunity to ask questions about medications Offer of service - encourage request to speak to pharmacist if any medication questions or concerns Time: 5-10 minutes Typical Student Day Arrive on the unit at approximately 8:00 AM Identify any new patients to the unit Determine patients ready for visit (Day#2) Work up 5 day length of stay patients and visit Nursing rounds at 10 AM Check in with pharmacist preceptor Complete discharge medication education as needed Outcome Measures Patient experience survey data Workload statistics for pharmacy teaching consultations Number and type of clinical contributions to care Number of patient and family experience observations including safety, service recovery, work orders, or requests Number of patient visits by student, contributing to nursing s hourly rounding goals

11 Given New Medicine? Side Effects Student #1 Student # Before giving (you/your family member) any new medicine, how often did hospital staff describe possible side effects in a way (you/he or she) could understand? Would you say: Indication Student #1 Student # Before giving (you/your family member) any new medicine, how often did hospital staff tell (you/your family member) what the medicine was for? Would you say:

12 Data Collection DATE Patient Sticker Visit Type Medications Discharge Extended LOS (>5days) POD #1 Nurse Request Physician Request Written Information Provided/ Placed in Folder Teaching Recorded in EMR Discharge Visit Completed Time Spent in Room TIME Patient visits per day 2-5 Profile review minutes Visit time 12 minutes, range 3-20 Documentation 5-10 minutes Nursing Rounds 30 minutes Pharmacist Contributions to Care Drug interactions Medication side effects -recommend alternative s Drug duplications (Percocet and Norco) Pain medication regimens optimization Correct medications prn pain with no specific indication (ie, Hydrocodone/APAP and APAP alone) Remove of 1-time doses to clean up profile (ie, 1-time Antibiotic pre-op) Correct patient history in record, compared to home regimen (ie, BID Zantac instead of Daily) Assist physicians requesting non-formulary products

13 Tips for Success Complete orientation promptly Build relationship with nursing staff, especially the admit/discharge nurse Be flexible and ready to see a patient even if only three minutes of chart review time Be prepared for questions about non-pharmacy topics (you are the doctor when you re in the room) Customer Service 5 P s - ask if patient needs anything beyond pharmacy-related items HCAHPS Overall Domain FY 2015 VBP Phone Adjusted Thresholds Rex FY2013 Rex FY2014 to date OVERALL Communication with Nurses Pain Management Responsiveness of Staff Communication about Meds Hospital Environment Communication with Doctors Discharge Information Care Transition *NEW* Questions Christine Z Dennis, PharmD, MBA Tonya Faulkner, RN, BSN, PCCN Rex Healthcare, Raleigh NC