Presentation on theme: "Engaging the C-suite to Advance Pharmacy Practice Providing quality patient care through progressive pharmacy practice The Pharmacists Role in Improving."— Presentation transcript:
Engaging the C-suite to Advance Pharmacy Practice Providing quality patient care through progressive pharmacy practice The Pharmacists 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 hospitals 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. 4
HCAHPS Questions 4 Screening Questions 5 Demographic Items 16 Questions on Patients 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
HCAHPS Questions 6
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 hospitals 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 patients 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 patients 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? –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 Education- Environment Patient not in the room Patient drowsy or unable to understand Visitors present Distracting environment 1.Robert M. Smith (1991, April). How people become effective learners. Adult Learning, p. 11.Adult Learning 2.Robert L. Steinbach (1993). The Adult Learner: Strategies for Success. (Menlo Park, CA: Crisp Publications.)The Adult Learner: Strategies for Success 3.http://www.newhorizons.org/lifelong/workplace/billington.htm
Barriers to Medication Education-- Adult Learning Patients 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 1.Robert M. Smith (1991, April). How people become effective learners. Adult Learning, p. 11.Adult Learning 2.Robert L. Steinbach (1993). The Adult Learner: Strategies for Success. (Menlo Park, CA: Crisp Publications.)The Adult Learner: Strategies for Success 3.http://www.newhorizons.org/lifelong/workplace/billington.htm
Enabling Medication Education Begin at a learners 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 1.Robert M. Smith (1991, April). How people become effective learners. Adult Learning, p. 11.Adult Learning 2.Robert L. Steinbach (1993). The Adult Learner: Strategies for Success. (Menlo Park, CA: Crisp Publications.)The Adult Learner: Strategies for Success 3.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 26 Medication Questions
Scenario A: Mrs. J. Doe 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
AnswerAudience Participation Correct answer is A, B, and D Always allow patients to ask questions In order to assess the patients 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
AnswerAudience 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. htmhttp://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