Transcript The Pharmacist’s Role in Improving the Bottom Line

Engaging the C-suite to Advance
Pharmacy Practice
Providing quality patient care through
progressive pharmacy practice
The Pharmacist’s Role in Improving
the Bottom Line
HCAHPS Overview
• Hospital Consumer Assessment of
Healthcare Providers and Systems
• Provide a standardized survey instrument
and data collection methodology for
measuring patients’ perspectives on
hospital care
• www.HospitalCompare.hhs.gov
Goals of HCAHPS Survey
• Produce data about patients’
perspectives of care that allow objective
comparisons of hospitals on topics that
are important to consumers
• Incentives for hospitals to improve quality
of care
• Enhance accountability in health care by
increasing transparency of the quality of
hospital care
HCAHPS Reimbursement Impact
• On November 1, 2006 CMS issued a final rule regarding the
Outpatient Prospective Payment System that was designed to
promote higher quality in outpatient care.
• Although the rule is primarily related to the Outpatient Prospective
Payment System, it also includes provisions for expanding the
quality reporting requirements for hospital inpatient services and
links submission of HCAHPS data - beginning with discharges in
July of 2007 - to the hospital’s market basket update for the 2008
fiscal year
• During the June "2010 ANI: The Healthcare Finance Conference"
held in Las Vegas by the Healthcare Financial Management
Association, it was estimated that HCAHPS scores would account
for 10 percent of each hospital's VBP ranking under the Medicare
program.
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HCAHPS Questions
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4 Screening Questions
5 Demographic Items
16 Questions on Patient’s Perspectives
8 Key Topics
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Communication with Doctors
Communication with Nurses
Responsiveness of Hospital Staff
Pain Control
Communication about Medicine
Environmental Cleanliness
Quietness of Hospitals
Discharge Information
HCAHPS Questions
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HCAHPS Questions
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CMS Rules: Communicating with
Patients about the HCAHPS Survey
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Hospitals are not allowed to:
– Ask any HCAHPS questions of patient prior to administration of the survey
– Attempt to influence or encourage patients to answer HCAHPS questions in a
particular way
– Indicate that the hospital’s goal is for all patients to rate them as a “10”,
“Definitely Yes” or an “Always”
– Imply that the hospital, its personnel or agents will be rewarded or gain
benefits for positive feedback from patients by asking patients to choose
certain responses such as a “10”, “Definitely Yes” or an “Always”
– Ask patients to explain why they did not rate a hospital with the most favorable
rating possible
– Offer incentives of any kind for participation in the survey
– Conduct any satisfaction or patient experience survey prior to the HCAHPS
survey being completed (While an inpatient or post discharge)
CMS CAHPS Hospital Survey (HCAHPS) Quality Assurance Guidelines, version 4.0
Guidance on Communicating with
Patients about HCAHPS
• Do not ask patients HCAHPS questions, questions
using the same language and/or response scale found
in the HCAHPS survey during patient interactions and
administrative rounds
• Do not wear buttons with the word “Always” on them
• Do not place posters about patient satisfaction and
experience in areas where the public can view them
• Discharge calls should focus on the patients’ clinical
condition and not their satisfaction
– The new survey process will provide timely feedback on
patients’ engagement and perception
Pain Management
• Discuss patient pain management expectations
at admission
• Discuss pain management options with patient
• Incorporate assessment into nursing hourly
rounding
• Make pain management changes 24 hours
prior to discharge
Example Pain Management Tools
Pain
Assessment
“Ruler”
Medication
Use
Evaluation
Tools
Opiate
Conversion
Chart
Medication Communication
• Medication administer to >99% of
patients.
Audience Participation
• Question: When should patients be told they
are receiving a new medication that they have
not taken before?
– A. When the physician prescribes the medication
– B. When the nurse administers the first dose of the
medication
– C. Every instance of medication administration
– D. When the patient is being discharged
– E. All of the above
Answer: Audience Participation
• Correct answer is E
• Medication education is everyone's
responsibility
• Recognize that the patient’s perception of
education may be different than ours
• Repeating medication education
reinforces the information
National Council on Patient Information and Education (2007). Enhancing prescription medicine adherence: A
national action plan.
Audience Participation
• Question: What percentage of patients
are aware of potential side effects related
to their medication?
– A. 1%
– B. 27%
– C. 51%
– D. 74%
– E. 99%
Patient Education and Counseling 56 (2005) 276-282
Answer: Audience Participation
• Correct answer is B
• Patients may not be aware of the side effects
of their medications
• Using the word “side effect” clarifies the
patient’s understanding and perception of the
medication
• When patients understand the side effects,
they are more likely to take their medication
Patient Education and Counseling 56 (2005) 276-282
HCAHPS: Medication
Administration
Role of the Pharmacist:
• Become proactive about gathering and providing
medication information to patients and nurses
• Ask the nurse and the patient questions to stimulate
dialog
• Work with hospital administration to increase
pharmacist/patient contact
• Incorporate patient communication skills and new
teaching methods into education sessions
Am J Health Syst Pharm. 2007 Mar 1;64(5):507-20.
Engaging Patient Care Staff
• Why is medication education important?
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Improves medication adherence / compliance
Increases familiarity with medication side effects
Promotes patient self monitoring
Encourages follow-up with care
The informed patient will understand the side effects
of prescribed medications and take them as
prescribed
National Council on Patient Information and Education (2007). Enhancing prescription medicine adherence: A
national action plan.
Medication Adherence
• 50% of patients report they had forgotten
to take a prescribed medication
• 31% had not filled a prescription they
were given
• 30% had stopped taking a medicine
before the supply ran out
• 24% had taken less than the
recommended dose
National Council on Patient Information and Education (2007). Enhancing prescription medicine adherence: A
national action plan.
Barriers to Medication EducationEnvironment
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Patient not in the room
Patient drowsy or unable to understand
Visitors present
Distracting environment
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Robert M. Smith (1991, April). How people become effective learners. Adult Learning, p. 11.
Robert L. Steinbach (1993). The Adult Learner: Strategies for Success. (Menlo Park, CA: Crisp Publications.)
http://www.newhorizons.org/lifelong/workplace/billington.htm
Barriers to Medication Education-Adult Learning
• Patient’s level of knowledge
• Patient does not understand the purpose of
education
• 75% of what is heard is forgotten after 2 days
• Patients may be disinterested in medication
education
• Memorization of information is insufficient to
change behavior
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Robert M. Smith (1991, April). How people become effective learners. Adult Learning, p. 11.
Robert L. Steinbach (1993). The Adult Learner: Strategies for Success. (Menlo Park, CA: Crisp Publications.)
http://www.newhorizons.org/lifelong/workplace/billington.htm
Enabling Medication Education
• Begin at a learner’s level
• Explain importance of medication
knowledge
• Patients remember 80% of what they
hear, see, and do
• Learning must be stimulating
• New information must be reinforced with
practical application
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Robert M. Smith (1991, April). How people become effective learners. Adult Learning, p. 11.
Robert L. Steinbach (1993). The Adult Learner: Strategies for Success. (Menlo Park, CA: Crisp Publications.)
http://www.newhorizons.org/lifelong/workplace/billington.htm
Medication Teaching Tools
• Drug Information Vendor Partner
• Notepad for patient questions
• “Sorry I missed you” tent
Drug Information Toolkit
• Partnering with Medication Information Vendor for Staff
Resources
• Printed Materials
• Cover Letter
• Sample MedCounselor patient education sheet
• Step‐by‐step sheet for accessing and printing patient
education
• Order form to request additional printed materials
• Printed postcards to promote the online Clinical
Pharmacology quiz
• Clinical Pharmacology Quick Reference Guides
HCAHPS Tools: Medication
Administration
• Provide a note pad
for the patient /
family to write down
questions about
medications
Notepad for Medication Questions
Medication Questions
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Scenario A: Mrs. J. Doe
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66 year old female
Presented to ED with heart palpitations
BP = 90/70
Pulse = 150 and irregular
Heart: Murmur audible at the apex
EKG: Atrial fibrillation with LBBB
Digoxin and beta blocker continued
Warfarin initiated (patient has never
received an anticoagulant)
Audience Participation
• What would the next step be in providing
education to this patient?
– A. Pause, allow the patient to ask questions
– B. Ask the patient a question to assess
understanding
– C. Continue describing side effects; ask the
patient to hold all questions until the end
– D. Give the patient a handout to reinforce
medication education session
Answer—Audience Participation
• Correct answer is A, B, and D
• Always allow patients to ask questions
• In order to assess the patient’s
understanding, it is important to ask
him/her questions
• Handouts will help reinforce the
medication education
Audience Participation
• If patients appears not to comprehend the
information, what is your next step?
– A. Continue teaching and document the details
provided during the education session
– B. Conclude the session and give them the
appropriate patient education handout
– C. Conclude the session and contact the physician
– D. Continue with education and let patients know
that this medication will be discussed throughout
their hospital stay
Answer—Audience Participation
• Correct answer is D
• Documenting education is important,
however not the complete answer
• A handout may provide structure to the
education session, however, additional
educational sessions may be necessary
• Communication should extend beyond
the physician to include the entire
healthcare team
Additional Reference:
National Council on Patient Information
and Education (2007). Enhancing
prescription medicine adherence: A
national action plan. PDF available
Resources for Patients
• www.safemedication.com
• http://www.ahrq.gov/qual/pillcard/pillcard.
htm
• www.tnpharm.org/BlankUML.pdf
Summary
• Various avenue of opportunity exists for
RPhs to improve quality metrics
• Ensure that quality measures are met by
integrating into the health care team
• Assess opportunities within the
medication administration process to
affect or participate in interactions