Enhanced PatientSafety Intervention To Optimize Medication Education EPITOME

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

• Specifically
• Increase patients perception of (satisfaction
  with) the delivery of medication education while
  in the hospital
• Simplify medication regimens as appropriate
• Decrease hospital readmissions

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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

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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

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The Safety Problem

• Medication adherence the extent to which a
  patients behavior is consistent with health care
  recommendations.
• Pilot results
• Multidisciplinary education and consultation
  improved
• Specific medication knowledge

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Specific Knowledge About Medication
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The Safety Problem

• Medication adherence the extent to which a
  patients behavior is consistent with health care
  recommendations.
• Pilot results
• Multidisciplinary education and consultation
  improved
• Specific medication knowledge
• Satisfaction with medication use education

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Global Satisfaction with Medication Education
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The Safety Problem

• Medication adherence the extent to which a
  patients 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

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The Safety Problem
Methods
Health Care Team
Little collaboration amongst disciplines
Staffing Shortages
Patient education left to day of discharge
Inconsistent knowledge of resources
Patients are not receiving adequate medication
education before leaving the hospital
Variability in the degree/amount of education
Hard to predict LOS
Inconsistent availability of teaching tools
High patient acuity and number of medications
High census and patient turnover
Generic teaching documentation forms
Resources
Patient
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The Intervention - EPITOME

• Conceptual framework
• There are three basic tools of medicinethe
  herb, the knife and the word.
• Health behavior change model
• Educate rapport, verbal/written
• Reinforce comprehension, consult
• Evaluate - barriers

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EPITOME

• Patient needs assessment of
• Oral medications
• Routine patient needs
• Complex medication regimens
• Pharmacist consultation

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EPITOME

• Education for all patients
• Timing
• Exclusion
• Surrogates
• Multidisciplinary approach
• Medicine
• Nursing

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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

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EPITOME

• Education for all patients
• Timing
• Exclusion
• Surrogates
• Multidisciplinary approach
• Medicine
• Nursing
• Pharmacy

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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

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EPITOME

• Education for all patients
• Timing
• Exclusion
• Surrogates
• Multidisciplinary approach
• Medicine
• Nursing
• Pharmacy
• Respiratory Therapy

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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

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EPITOME

• Training staffing
• Patient materials
• Links to HIT
• Medical record documentation
• Auditing implementation performance
• Trouble shooting
• Rapid sequence performance improvement efforts

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EPITOME

• Outcomes assessment
• Patient satisfaction and awareness

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

Threshold4
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EPITOME

• Outcomes assessment
• Patient satisfaction and awareness
• Medication error identification and prevention
• Complexity of medication regimen (simplification)
• Hospital readmission

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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

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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

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Dissemination Steps

• What worked
• What needs to be improved