Poor health literacy — the kind found in Kentucky — and complex medication regimens-the kind found in every health system—create the perfect opportunity for patients leaving the hospital to fail at home. In response, UK HealthCare charged a multidisciplinary team with making the patient’s transition to home easier by helping them or their caregivers learn how to properly take their medicines at home. The team responded by creating an enhanced medication list with instructions on how the patient should take their medicines at home, including when, how, and what to stop taking.
In May 2013, a multidisciplinary team proposed to executive leadership an innovative and integrated project aimed at incorporating patient’s discharge medication list into a medication schedule. Across our nation, and potentially in no individual state more that KY, the healthcare community is challenged with exceptionally poor health literacy. Combined with epidemic poly-pharmacy and complex medication regimens, patients often leave hospital stays confused about how to take their medications and are at high risk of medication-related adverse reaction. There were still important links missing regarding presentation of medications to patients and caregivers and delivery of medication-related education.
The goal was for patients to better understand “How I should take my medications?” Knowledge conferred to patients by nursing and pharmacy staff regarding discharge medications and expected side effects are now coupled with instructional visual tools. In addition to a medication schedule (morning, noon, evening, and bedtime) for each medication that should be taken post-discharge, each note also addresses which medication the patient should stop taking (from previous outpatient medications). The tool also provides written instructions to the patient regarding what to do when they identify “missing medications,” not addressed on their medication schedule, when they return home. Possibly the most important addition to this team were patient education and health literacy experts who help ensure that true patient understanding was possible by meeting our patient population’s unique needs. These enhancements have been further supported with the widespread availability of discharge prescription delivery services, providing an opportunity for us to offer an enhanced medication-related discharge experience in a way very few institutions have been able to achieve.
The novel product is a calendar-style tool that not only shows what medicines to take, but at what time on each day, what route, and what medicines to stop taking.
Anecdotally, use of this tool has allowed the medication education conversation to progress to a deeper understanding of “what medications are for” and “what potential side effects” for these therapies. We also believe that we will see these changes impact our preventable medication-related errors and readmission rate metrics. The most significant measurable impact will be on our medication and care transition HCAHPS scores.