IHI Expedition Expedition: Improving Medication Safety from the - - PowerPoint PPT Presentation
March 12, 2015 These presenters have nothing to disclose IHI Expedition Expedition: Improving Medication Safety from the Patients Perspective Session 2: Health Literacy and Medication Safety Gail A. Nielsen, BSHCA, FAHRA Frank Federico,
Expedition: Improving Medication Safety from the Patient’s Perspective Session 2: Health Literacy and Medication Safety March 12, 2015
These presenters have nothing to disclose
Gail A. Nielsen, BSHCA, FAHRA Frank Federico, RPh Joelle Baehrend
2
Dorian Burks
Project Coordinator Institute for Healthcare Improvement
3
T
1) Click on the “Participants” and “Chat” icons in the top right hand side of your screen. 2) Click the button
the screen. 3) A pop-up box will appear with the option “I will call in.” Click that
4) Please dial the phone number, the event number and your attendee ID to connect correctly .
“All Participants” for questions
issues only, please chat to “Host”
4
Enter Text Select Chat recipient Raise your hand
5
Please send your message to All Participants
6
Joelle Baehrend
Director Institute for Healthcare Improvement
7
Session 1 – Improving Polypharmacy
Faculty : Robert Feroli, PharmD and Amanda Brummel, PharmD, BCACP
Session 2 – Health Literacy and Medication Safety
Faculty : Gail Nielsen, BSHCA, FAHRA
Session 3 – Improving Medication Adherence
Faculty : William Strull, MD
Session 4 – Medication Reconciliation
Faculty : Anne Myrka, RPh, MAT
Session 5 – Safe Management of Newly Released Anticoagulants and High-Alert Medications
Faculty : L. Hayley Burgess, PharmD
8
– What did you learn about your organization’s process
for medication therapy management and efforts to reduce polypharmacy where appropriate?
– Any surprises?
Health Literacy: My hospital has a process for assessing patients’ ability to understand instructions related to their medications.
10
11
Frank Federico, RPh
Executive Director, Strategic Partners Institute for Healthcare Improvement
12
Gail A. Nielsen, BSHCA, FAHRA
Fellow & Patient Safety Scholar Institute for Healthcare Improvement
Gail Nielsen
These presenters have nothing to disclose
March 12, 2015
Lower health literacy is associated with poorer health
worse disease control Literacy is a stronger predictor of worse outcomes than age, income, employment status, educational level or racial or ethnic group Better health literacy is associated with a lower prevalence of diabetes
Baker DW, Gazmararian JA, Williams MV, et al. Functional health literacy and the risk of hospital admission among medicare managed care enrollees. Am J of Public Health. 2002;92(8):1278-83 Schillinger D, Grumbach K, PietteJ, et al. Association of health literacy with diabetes outcomes. JAMA. 2002;288(4):475- 82 Schillinger D, et al. Closing the loop: physician communication with diabetic patients who have low health
Med errors and adverse drug events Unrealistic optimism of patient and family to manage self-care and medications Patient lack of adherence to do self-care e.g., take medications, because of:
–
Poor understanding or confusion about how to use, access, or pay for medications
–
Self-care instructions that are confusing, contradictory to other instructions, or are not tailored to a patient’s level of health literacy
–
Medication discrepancies in handover information
ADEs account for 2/3s of post- discharge complications occurring within 3 weeks of hospital discharge
24% were judged preventable [1]
In a similar study, 27% were judged preventable; 33% ameliorable [2].
http://www.health.gov/hai/pdfs/ADE-Action-Plan-508c.pdf
survey of 126 U.S. hospitals. J Hosp Med. 2009;4(9):E7-E14.
diabetic in-patients: clinical or criminal?. PLoS ONE. 2012;7(7):e40384.
Traditional Focus Transformational Focus
Clinician teaching What are the patient and family caregivers learning? Patients are the recipients
the care team Patient and family members are essential and active members of the care team
activities - taking medications
to medications
Example: “I want to be sure that I did a good job of teaching you today about how to take this new
words how you will take it at home?”
– What will be hard about taking this medicine? – What worries you about taking your medications? – Have we missed anything? – Who helps you with your medications?
non-pharmacy staff
taking medications
language and techniques
habits for teach-back
1.
Use a caring tone of voice and attitude
2.
Display comfortable body language and make eye contact
3.
Use plain language
4.
Ask the patient to explain back, using their own words
5.
Use non-shaming, open-ended questions
6.
Avoid asking questions that can be answered with a simple yes or no
7.
Emphasize the responsibility to explain clearly is on you, the provider
8.
If the patient is not able to teach back correctly, explain again and re-check
9.
Use reader-friendly print materials to support learning
27
Hospital Primary & Specialty Care Home Health Care Home (Patient & Family Caregivers)
…use the same core content and teaching materials in all community patient care settings?
Rutherford P, Nielsen GA, Taylor J, Bradke P, Coleman E. How-to Guide: Improving Transitions from the Hospital to Community Settings to Reduce Avoidable Rehospitalizations. Cambridge, MA: Institute for Healthcare Improvement; June 2013. Available at www.IHI.org.
Pharmacy Health Literacy Assessment Tool & User's Guide Training program for pharmacy staff on communication Guide on how-to create a pill card Telephone reminder tool to help refill medicines on time Explicit and standardized prescription medicine instructions
http://www.ahrq.gov/professionals/quality-patient-safety/pharmhealthlit/tools.html
Communication
Changes
http://www.health.gov/communication/hlactionplan/pdf/Healt h_Literacy_Action_Plan.pdf
Linking limited health literacy to misunderstanding instructions about prescription medication, medication errors, poor comprehension of nutrition labels, and mortality:
(2006). Low literacy impairs comprehension of prescription drug warning labels. Journal of General Internal Medicine, 21(8), 847–851.
Medicine, 145(12), 887– 894.
(2006). Patient understanding of food labels: The role of literacy and numeracy. American Journal of Preventive Medicine, 31(5), 391–398.
Misunderstanding of prescription drug warning labels among patients with low literacy. American Journal of HealthSystem Pharmacy, 63, 1048–1055.
cognitive abilities, and mortality among elderly persons. Journal of General Internal Medicine, 23(6), 723–726.
Functional health literacy in patients with glaucoma in urban settings. Archives of Ophthalmology, 126(5), 718–724
http://www.health.gov/communication/hlactionpl an/pdf/Health_Literacy_Action_Plan.pdf
Creating standards and guidelines to improve the communication of information on prescription labels The United States Pharmacopeia and the National Association of Boards of Pharmacy both have initiatives to create standards and guidelines to improve the communication of information on prescription labels.
National Association of Boards of Pharmacy. (2009, February). Report of the Task Force on Uniform Prescription Labeling Requirements. Mount Prospect, IL: Author. U.S. Pharmacopeia. (2009). 2008 Health literacy and prescription container labeling advisory panel: Meeting 2. Rockville, MD: U.S. Pharmacopeia.
http://www.health.gov/communication/hlacti
http://www.health.gov/hai/pdfs/ADE-Action-Plan-508c.pdf
Initial targets of the ADE Action Plan:
Approach to reduce patient harms from these three ADEs:
http://iom.edu/Activities/PublicHealth/HealthLiteracy/2014-MAR- 17.aspx?utm_medium=etmail&utm_source=Institute%20of%20Medicine&u tm_campaign=03.17.14+Health+Lit+webcast&utm_content=&utm_term
35
Roundtable on Health Literacy Board on Population Health and Public Health Practice
36
Raise your hand Use the chat
Review your organization’s patient literature for three medications and ask patients to read it and provide feedback on understanding of content
– Please be prepared to share on our next session
38
William Strull, MD
Medical Director for Quality and Patient Safety The Permanente Foundation
39
Thursday, March 26th, 1:00 – 2:00 PM ET
40
Joelle Baehrend jbaehrend@ihi.org Dorian Burks dburks@IHI.org