Increasing HCAHPS Through Better Medication Communication

The Impact of Medication Clarity

The HCAHPS survey measures the patient experience over a wide range of domains, from environmental cleanliness to staff responsiveness. Communication is another theme across many domains, and for good reason: Without clear communication, patients cannot be engaged members of the care team.

Medication communication in particular holds weight, with a dedicated domain and the potential to influence several others, like communication with nurses and doctors, discharge information, and understanding care after leaving the hospital.

The HCAHPS questions covering medication communication are:

Question 13. Before giving you any new medicine, how often did hospital staff tell you what the medicine was for?

Question 14. Before giving you any new medicine, how often did hospital staff describe possible side effects in a way you could understand?

Question 22. When I left the hospital, I clearly understood the purpose for taking each of my medications.

The OAS CAHPS survey also addresses medication communication in two questions:

Question 13. Discharge instructions include things like symptoms you should watch for after your procedure, instructions about medicines, and home care. Before you left the facility, did you get written discharge instructions?

Question 15. Some ways to control pain include prescription medicine, over-the-counter pain relievers or ice packs. Did your doctor or anyone from the facility give you information about what to do if you had pain as a result of your procedure?

This focus on medication communication is not surprising, given that medication adherence is one of the highest-impact factors affecting patient safety. Medication errors are a leading cause of death, estimated to cause 44,000 to 98,000 deaths each year in the United States — more than the number caused by motor vehicle accidents. Medication errors cause a fifth of hospital readmissions, and for certain conditions, such as heart failure, they can be the best predictor of whether a patient will be readmitted to the hospital.

Clear communication is critical to help avoid medication errors. Patients must know what they are taking, why they are taking it, and how to take it. However, there can be a big gap when it comes to medication communication in the hospital. A recent study in JAMA reported that 27% of patients received no verbal instruction on medication changes before hospital discharge and 53% were informed about medication changes but not the reason for them. This could explain why around 50% of patients are not taking their medications as prescribed.

Barriers to medication communication

Despite the profound impact of medication communication on patient safety and the patient experience, healthcare teams can struggle to implement it well. It is difficult for nurses in a short-staffed environment to meet patient needs. Teaching can get put on the back burner and crowded into a short session right before discharge.

It may also be difficult to locate and print out information to cover all the medications patients are taking. In one study, hospital nurses identified problems they faced with medication teaching. They cited lack of available quality patient medication handouts, limited time to educate, and uncertainty about how much was expected of them.

Without handouts and education materials, nurses may rely on their professional knowledge to educate patients, but this can be inadequate and vary greatly based on experience. Moreover, the complexity of medication teaching can’t be overstated. Over 20,000 medications are available for prescribing in the US, plus countless over-the-counter medications, herbs, and supplements. Add to this long lists of side effects and potential interactions for each, and it’s no wonder that it’s challenging to identify and communicate what patients need to know.

How to improve medication communication

To improve medication adherence and related HCAHPS and OAS CAHPS scores, use the following strategies in medication teaching:

• Provide written materials and tools. It’s impossible for nurses to rely on only professional knowledge to cover the necessary medication information. Easily accessible materials can help them give complete instructions.

• Teach-back to check understanding. Have patients repeat what was taught to check that they understand. Using teach-back can also activate multiple learning styles to improve recall.

• Use multiple touchpoints. Every medication administration is an opportunity to teach. Nurses can review what the medication is, what it is for, and possible side effects to watch for. Having reliable references at hand makes this level of teaching possible.

Despite the wide range of potential medications a doctor can prescribe, about 20 medications account for around 25% of all prescriptions in the US, according to prescription claims reports. Because of this, a simple, easy-to-use tool covering these common medications can be a huge help to healthcare teams teaching at the bedside.

Common Medication Names, Uses and Side Effects in the Patient Resource Library available from Patient Guide Solutions helps patients understand what side effects to watch for and how to take these medications safely. Plus, with a reliable reference to access later, patients can look up any information they forget.

Conclusion

With the right tools and strategies, healthcare providers can foster better patient engagement in medication teaching, improve medication compliance, and boost overall HCAHPS and OAS CAHPS scores — a critical move for patient safety and experience.