Presentation on theme: "The Pharmacist’s Role in Improving the Bottom Line"— Presentation transcript:
1 The Pharmacist’s Role in Improving the Bottom Line
2 HCAHPS OverviewHospital Consumer Assessment of Healthcare Providers and SystemsProvide a standardized survey instrument and data collection methodology for measuring patients’ perspectives on hospital care
3 Goals of HCAHPS SurveyProduce data about patients’ perspectives of care that allow objective comparisons of hospitals on topics that are important to consumersIncentives for hospitals to improve quality of careEnhance accountability in health care by increasing transparency of the quality of hospital care
4 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 to the hospital’s market basket update for the 2008 fiscal yearDuring 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.
5 HCAHPS Questions 4 Screening Questions 5 Demographic Items 16 Questions on Patient’s Perspectives8 Key TopicsCommunication with DoctorsCommunication with NursesResponsiveness of Hospital StaffPain ControlCommunication about MedicineEnvironmental CleanlinessQuietness of HospitalsDischarge Information
6 HCAHPS QuestionsSomers’d test- determines the strength of the relationship between the question and the overall satisfaction scoreThere is also another type of Ordinal association called Somer’s d. Somer’s d reaches the maximum value of 1 in cases of positive relationships, and the minimum value of -1 in cases of negative relationships under the condition of strict monotonicity. The null relationship in Somer’s d is defined as statistical independence. Somer’s d is used only with the ordinal type of data level. In the case of two by two tables, Somer’s d is equivalent to the percent differences measured in dichotomous association. Somer’s d is an asymmetric kind of measure of ordinal association. Ordinal association refers to that type of association in which the categorical variables follow a pattern, like a scale from best to worst or from most likely to least likely, etc. Ordinal association refers to the extensive study of the relationship between the different positions of the same set of items.
8 CMS Rules: Communicating with Patients about the HCAHPS Survey Hospitals are not allowed to:Ask any HCAHPS questions of patient prior to administration of the surveyAttempt to influence or encourage patients to answer HCAHPS questions in a particular wayIndicate 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 possibleOffer incentives of any kind for participation in the surveyConduct 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
9 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 roundsDo not wear buttons with the word “Always” on themDo not place posters about patient satisfaction and experience in areas where the public can view themDischarge calls should focus on the patients’ clinical condition and not their satisfactionThe new survey process will provide timely feedback on patients’ engagement and perception
10 Pain ManagementDiscuss patient pain management expectations at admissionDiscuss pain management options with patientIncorporate assessment into nursing hourly roundingMake pain management changes 24 hours prior to discharge
11 Example Pain Management Tools Pain Assessment“Ruler”Medication Use Evaluation ToolsOpiate Conversion ChartPain Rounds-riversideHourly Rounding
12 Medication Communication Medication administer to >99% of patients.
13 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 medicationB. When the nurse administers the first dose of the medicationC. Every instance of medication administrationD. When the patient is being dischargedE. All of the above
14 Answer: Audience Participation Correct answer is EMedication education is everyone's responsibilityRecognize that the patient’s perception of education may be different than oursRepeating medication education reinforces the informationNational Council on Patient Information and Education (2007). Enhancing prescription medicine adherence: A national action plan.
15 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)
16 Answer: Audience Participation Correct answer is BPatients may not be aware of the side effects of their medicationsUsing the word “side effect” clarifies the patient’s understanding and perception of the medicationWhen patients understand the side effects, they are more likely to take their medicationPatient Education and Counseling 56 (2005)
17 HCAHPS: Medication Administration Role of the Pharmacist:Become proactive about gathering and providing medication information to patients and nursesAsk the nurse and the patient questions to stimulate dialogWork with hospital administration to increase pharmacist/patient contactIncorporate patient communication skills and new teaching methods into education sessionsAm J Health Syst Pharm Mar 1;64(5):
18 Engaging Patient Care Staff Why is medication education important?Improves medication adherence / complianceIncreases familiarity with medication side effectsPromotes patient self monitoringEncourages follow-up with careThe informed patient will understand the side effects of prescribed medications and take them as prescribedNational Council on Patient Information and Education (2007). Enhancing prescription medicine adherence: A national action plan.
19 Medication Adherence50% of patients report they had forgotten to take a prescribed medication31% had not filled a prescription they were given30% had stopped taking a medicine before the supply ran out24% had taken less than the recommended doseNational Council on Patient Information and Education (2007). Enhancing prescription medicine adherence: A national action plan.
20 Barriers to Medication Education- Environment Patient not in the roomPatient drowsy or unable to understandVisitors presentDistracting environmentRobert 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.)
21 Barriers to Medication Education--Adult Learning Patient’s level of knowledgePatient does not understand the purpose of education75% of what is heard is forgotten after 2 daysPatients may be disinterested in medication educationMemorization of information is insufficient to change behaviorRobert 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.)
22 Enabling Medication Education Begin at a learner’s levelExplain importance of medication knowledgePatients remember 80% of what they hear, see, and doLearning must be stimulatingNew information must be reinforced with practical applicationRobert 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.)
23 Medication Teaching Tools Drug Information Vendor PartnerNotepad for patient questions“Sorry I missed you” tent
24 Drug Information Toolkit Partnering with Medication Information Vendor for Staff ResourcesPrinted MaterialsCover LetterSample MedCounselor patient education sheetStep‐by‐step sheet for accessing and printing patient educationOrder form to request additional printed materialsPrinted postcards to promote the online Clinical Pharmacology quizClinical Pharmacology Quick Reference Guides
25 HCAHPS Tools: Medication Administration Provide a note pad for the patient / family to write down questions about medications
27 Scenario A: Mrs. J. Doe 66 year old female Presented to ED with heart palpitationsBP = 90/ Pulse = 150 and irregularHeart: Murmur audible at the apexEKG: Atrial fibrillation with LBBBDigoxin and beta blocker continuedWarfarin initiated (patient has never received an anticoagulant)
28 Audience Participation What would the next step be in providing education to this patient?A. Pause, allow the patient to ask questionsB. Ask the patient a question to assess understandingC. Continue describing side effects; ask the patient to hold all questions until the endD. Give the patient a handout to reinforce medication education session
29 Answer—Audience Participation Correct answer is A, B, and DAlways allow patients to ask questionsIn order to assess the patient’s understanding, it is important to ask him/her questionsHandouts will help reinforce the medication education
30 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 sessionB. Conclude the session and give them the appropriate patient education handoutC. Conclude the session and contact the physicianD. Continue with education and let patients know that this medication will be discussed throughout their hospital stay
31 Answer—Audience Participation Correct answer is DDocumenting education is important, however not the complete answerA handout may provide structure to the education session, however, additional educational sessions may be necessaryCommunication should extend beyond the physician to include the entire healthcare team
32 Additional Reference: National Council on Patient Information and Education (2007). Enhancing prescription medicine adherence: A national action plan. PDF available
34 SummaryVarious avenue of opportunity exists for RPhs to improve quality metricsEnsure that quality measures are met by integrating into the health care teamAssess opportunities within the medication administration process to affect or participate in interactions