Patients understanding their medications and taking them as instructed are important parts of improving the care and outcomes of heart attack patients, as well as potentially reducing avoidable readmissions, according to research presented at the ACC Quality Summit in New Orleans.
A heart attack is typically an unexpected event, which can leave patients overwhelmed by new medications, clinicians and other additions to their health care upon release from the hospital. When patients are discharged from the hospital, hospital staff educate them about their medications. However, many patients have difficulty understanding and following these instructions.
A new quality improvement plan, developed at Olathe Medical Center in Olathe, Kansas, and initiated as part of the American College of Cardiology's Patient Navigator Program: Focus MI, showed promising results and shed light on how to approach the issue. The study group considered the patient perspective on the hospital discharge and follow-up experience when developing solutions.
"When patients leave a hospital, they often feel there has been little preparation for the discharge plan of care," said Tara See, RN, BSN, Olathe Medical Center and a leader in the initiative. "Another complaint is that follow-up care is not well established at discharge, there is limited communication with providers receiving them after hospitalization, medication reconciliation and instructions may be hard to understand, and expectations are unclear regarding their recovery and needs when they are discharged."
In April 2018, an interdisciplinary team at Olathe Medical Center, including an assigned bedside RN, cardiology nurse navigator, floor pharmacists and outpatient cardiac rehab staff, established and implemented the following medication education communication process:
- After a patient is admitted, an assigned bedside nurse reviews any new medications with the patient, family member, or caregiver, including what they are used for and any side effects of that particular medication. "This can be easily done through patient medication cards that are premade and ready to go," See said.
- Once the discharge medications have been prescribed by the physician, the cardiology nurse navigator asks the patient to write out medication information on a visual aid form called a medication log. This include the names of their discharge medications, what the medications are used for, dose, frequency and what time of day the medications should be taken. See said, "This can be done in conjunction with the floor pharmacist's instructions at discharge or done separately depending on similar availability."
- Next, the floor pharmacist educates the patient in greater depth about their medications, explaining potential side effects and any drug interactions, what to do if a dose is missed and offering any other needed instructions.
- After discharge, the patient will receive a transition of care phone call within 48 hours from a care coordinator or the nurse navigator. This call includes medication teach back, which requires the patient to read back from memory or read from their prescription bottles the name and usage of their medication.
- At the patient's first outpatient cardiac rehab appointment, they are asked to place a check mark by their current medications from a list of common cardiac medications. This helps ensure they are knowledgeable about their medications.
Using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey--a satisfaction survey required by the Centers for Medicare and Medicaid Services for all U.S. hospitals, the study group found the hospital's HCAHPS scores for medication understanding increased by 10 percent between quarter one and quarter two in 2018 following program implementation. Additionally, before plan implementation, the 2018 quarter one unadjusted readmission rate was 8.2 percent. Since implementation, the quarter two rate went down to 3.4 percent and quarter three was 3.6 percent.
"We realize improving medication understanding is only part of what hospitals need to do to help reduce readmissions," See said. "We are also continuing to focus on other goals, such as increasing risk assessment and appropriate interventions placed on high risk patients. We believe this will optimize our process and further decrease readmissions."
About the Patient Navigator Program: Focus MI
With 1 out of every 5 patients diagnosed with an acute myocardial infarction (AMI) readmitted to the hospital within 30-days of discharge, preventing avoidable readmissions is a national priority.
The ACC's Patient Navigator Program has successfully worked with select hospitals around the country to implement interventions aimed at bridging gaps between inpatient and outpatient AMI care through 30-days post hospitalization. Hospitals participating in the Patient Navigator Program have reported increases in the number of AMI patients assessed for risk of readmissions and greater understanding among MI and heart failure patients about their medications. In addition, they have successfully reached patients with education and community resources aimed at ensuring smoother patient transitions from the hospital to home.
The ACC's Patient Navigator Program: Focus MI builds on the success of the ACC Patient Navigator Program and is designed to pull evidence-based best practices to improve the care and outcomes of acute myocardial infarction (MI) patients and further reduce avoidable hospital readmissions beyond 30 days.
The American College of Cardiology envisions a world where innovation and knowledge optimize cardiovascular care and outcomes. As the professional home for the entire cardiovascular care team, the mission of the College and its more than 52,000 members is to transform cardiovascular care and to improve heart health. The ACC bestows credentials upon cardiovascular professionals who meet stringent qualifications and leads in the formation of health policy, standards and guidelines. The College also provides professional medical education, disseminates cardiovascular research through its world-renowned JACC Journals, operates national registries to measure and improve care, and offers cardiovascular accreditation to hospitals and institutions. For more, visit acc.org.