As healthcare practitioners and administrators, we are keenly aware of the complexities associated with preventing readmissions
. Common questions that come to mind when tackling the readmissions dilemma include: What patient care and education interventions can we implement? Do we have a solid transition of care program
? What is the cost impact to my organization, from direct costs to loss in reimbursement? Most importantly, how can we embed sustainable programs to avoid readmissions?
Take for example the impact of medication management
related issues as a factor for readmissions. In an evaluation conducted by Feignbaum, et al. at Kaiser Permanente, researchers studied factors contributing to readmissions within 18 hospitals (1). Medication management issues impacted 28 percent of preventable readmissions
and were identified as one of the top five areas for to prioritize for organizational intervention programs
. Upon interviewing 189 patients and caregivers, researchers found that 32 percent of patients indicated they would have liked to have received more communication regarding their medications, and of these, 73 percent of caregivers indicated that lack of information was one of the components that lead to a readmission (1). This data, coupled with a recently published article by Mixon, et al. focusing on post-discharge medication errors, highlights a significant area of opportunity to prevent medication management related issues
. The study indicates that medication errors ranging from omissions, commissions, and misunderstanding in indication, dose, and frequency were found in 50 percent of patients after hospital discharge (2). The groups most impacted were those with low health literacy and numeracy scores (2). These statistics are sobering and should make us want to re-evaluate our current approach towards medication-related patient education
in order to improve our practices to reduce the risk for patient harm and eliminate avoidable readmissions.
When creating a strategic approach to reduce medication management related readmissions
and errors, organizations should consider the following areas of improvement:
- Integrate medication handouts into Electronic Health Records (EHR) to optimize clinician work flow and enhance the patient discharge process
- Provide patient education handouts that adhere to health literacy standards to improve patient comprehension and retention of medication management related topics with tools designed for those with greatest risk of non-compliance (low health literacy and numeracy)
- Embed a “Teach-back Process” to validate patient and/or caregiver comprehension of the medication management related information provided
- Provide low-literacy aids to augment learning with tools such as pill-boxes, text messages, and/or daily medication schedules
These interventions are not only meaningful for the clinical outcome improvement results they can provide, but they are also aligned with safety, regulatory standards, and compliance standards that lead to higher reimbursement payments
. These incented standards range from reduction in readmissions related to medication management events, to attestation for Meaningful Use Stage II criteria for integrated patient education and improving patient satisfaction scores as evaluated by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey.
Pharmacists, physicians and nurses, it’s time to ask yourself how your organization is approaching medication-related patient education. Has your organization mobilized the medication-related experts who impact care decisions at the point of care? Do you have the opportunity to improve your work flow to make time for caregivers to exercise best practices in education on discharge? Do you know how many patients you are discharging with medication errors? These questions can help you on the journey to reduce your medication management related risk and improve your organizational approach.
Arti Bhavsar, Pharm.D.