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The Pharmacist’s Role in Improving the Bottom Line

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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 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

3 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

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 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.

5 HCAHPS Questions 4 Screening Questions 5 Demographic Items
16 Questions on Patient’s Perspectives 8 Key Topics Communication with Doctors Communication with Nurses Responsiveness of Hospital Staff Pain Control Communication about Medicine Environmental Cleanliness Quietness of Hospitals Discharge Information

6 HCAHPS Questions Somers’d test- determines the strength of the relationship between the question and the overall satisfaction score There 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.

7 HCAHPS Questions

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 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

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 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

10 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

11 Example Pain Management Tools
Pain Assessment “Ruler” Medication Use Evaluation Tools Opiate Conversion Chart Pain Rounds-riverside Hourly 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 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

14 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.

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 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)

17 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 Mar 1;64(5):

18 Engaging Patient Care Staff
Why is medication education important? 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.

19 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.

20 Barriers to Medication Education- Environment
Patient not in the room Patient drowsy or unable to understand Visitors present Distracting environment 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.)

21 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 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.)

22 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 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.)

23 Medication Teaching Tools
Drug Information Vendor Partner Notepad for patient questions “Sorry I missed you” tent

24 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

25 HCAHPS Tools: Medication Administration
Provide a note pad for the patient / family to write down questions about medications

26 Notepad for Medication Questions

27 Scenario A: Mrs. J. Doe 66 year old female
Presented to ED with heart palpitations BP = 90/ 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)

28 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

29 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

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 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

31 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

32 Additional Reference:
National Council on Patient Information and Education (2007). Enhancing prescription medicine adherence: A national action plan. PDF available

33 Resources for Patients

34 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


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