Nurses and hospital medication management — improving patient care and outcomes

Medication errors are an all-too-common problem in the U.S. In fact, they affect nearly 5 percent of the nation's hospitalized patients, according to the Agency for Healthcare Research and Quality. In addition to being detrimental to patient care, medication errors also pose a significant financial risk to hospitals' bottom lines — the Network for Excellence in Health Innovation estimates preventable inpatient medication errors can cost roughly $16.4 billion annually.

Adverse drug events can also lead to readmissions. For instance, roughly 19 percent of discharged patients experience an adverse event post-discharge, and two-thirds of those events are attributable to medications, according to a study in the Annals of Internal Medicine conducted in the early 2000s. Those adverse events can increase the risk of readmissions, which can have a negative impact on patient outcomes and hospital finances.

This content is sponsored by TRC

Medication management and education are crucial for preventing adverse events and readmissions. Such initiatives can also affect patient experience scores given that three questions on the HCAHPS survey are related to communication about medication information.

Medication management influences patient outcomes, patient experience and cost. Medication management sits on a unique intersection of metrics that affect patient care and reimbursement in the value-based payment world. As such, it has received more attention in recent years from hospital leaders looking to improve three key areas at once.

Challenges Associated with Effective Medication Management

Proper medication management has become difficult for providers, according to Katherine Kenny, DNP, RN, associate dean of academic affairs at Arizona State University's College of Nursing & Health Innovation and director of research and professional practice at Dignity Health's Chandler Regional Medical Center.

"Today, one of the biggest issues is knowing the names and classes of medications," Dr. Kenny says. Several formulations of the same medication are available on the market under different trade names, complicating medication management for nurses and other clinicians.

Medication reconciliation involves reviewing a patient's complete medication regimen to ensure no drugs are duplicates or unnecessary, and the process has become more important of late.

"Critical thinking with medication reconciliation is one of the key processes that nurses perform upon admission to the hospital and upon discharge," Dr. Kenny says.

Patients are coming into the hospital with an increasing number of chronic illnesses that require more medications. In addition to critical thinking, seamless coordination of care is also imperative for effective medication reconciliation. Sometimes, there are duplicates of medication classes or medications that shouldn't be taken together — however, in the case of siloed care, it's possible that multiple providers may not notice risky drug combinations until the patient is admitted to a hospital.

Several players are involved in the sport of medication management: the physician, nurse practitioner or physician assistant who prescribes the drug, the pharmacist, and the patient.

But perhaps the person in the hospital with the most integral, influential role in the process is the front-line nurse.

"The nurse is truly the last person at the end point of the trail before medication gets to the patient," Dr. Kenny explains. "It's a major role; no one else in the hospital has that responsibility…they are uniquely situated to make an error but also to prevent an error."

How to Support Nurses and Optimize Medication Management

Supporting hospital front-line nurses with new medication learning tools can be an effective way to prevent errors, improve medication management and thereby bolster patient care and patient experience scores. Certain tools help nurses stay up-to-date and sharp on new medications, all of which drives increased confidence among nurses as they interact with patients.

Hospitals that make these types of resources available, and make them part of the core lifelong learning process for the nursing team, are in a good position to prepare their staff to do a better job with medication management overall.

TRC, a medication learning company, now offers Nurse's Letter, an online medication learning tool that aims to "help improve care, outcomes and medication learning through concise, trusted, evidence-based recommendations and education," says Sherri Boehringer, PharmD, vice president and senior editor of TRC.

Each monthly edition of Nurse's Letter features at least 10 short articles which provide advice on new medications, important trial results, proper medication administration, medication safety and strategies to increase medication adherence. The monthly content also contains drug therapy comparison charts and patient handouts in English and Spanish to help patients stick with their medication regimens.

The whole publication is written by pharmacists, vetted by nurses and is free from pharmaceutical influence and any advertising.

How it's Done

It starts with the writing core. Experienced pharmacists, some of whom still practice, write the content and edit the monthly Nurse's Letter. These pharmacists all have doctoral degrees and 10 years of hospital experience on average. The lead editor pharmacist has more than 20 years of experience.

With an experienced team in place, TRC then relies on a rigorous, evidence-based, multi-step editorial process.

To make sure Nurse's Letter covers topics important to nurses, TRC determines the "big questions" every month. These big questions are pivotal to TRC's editorial process and are one differentiator from current nurse resources. It's through the big questions that editors succinctly answer the common questions healthcare providers not only encounter, but need to know in their daily practice.  

To identify these big questions that nurses both need and want to know, the TRC staff scours journals, blogs and government statements and also monitors the lay press. Subscribers also write or call with medication therapy questions, according to Dr. Boehringer.  

These efforts result in TRC's editors accumulating more than 1,500 big questions each month.

To narrow these big questions down to the most critical, TRC hosts a monthly webinar with its editors as well as healthcare providers from various disciplines to identify the most relevant, practical and timely topics.

Then, editors research the topics that have resulted from the big questions and build evidence-based recommendations around them. They do this by evaluating significant research from journals and communicating directly with national guideline authors, specialists and government agencies like the Drug Enforcement Agency and the Food and Drug Administration. Finally, they draft the content and distill it down to just the most pertinent points. Each article — which can be read in five minutes or less and average less than 30 lines of text — features five or six medication therapy recommendations and suggested resources to find more information.

Additionally, each recommendation is vetted through a six-step review process by specialists and front-line clinicians.

"We refine each sentence and word to make sure it's as clear as can be, 100 percent evidence-based and practical," says Dr. Boehringer.

Benefits in Today's Environment

Studies have linked the introduction of educational medication tools in healthcare organizations to decreased hospitalization rates and readmissions. An ACO in Kentucky and Indiana with 50 physicians and 12,000 Medicare patients implemented TRC's Prescriber's Letter — a tool similar to Nurse's Letter but aimed at prescribers — and saw a 26 percent decrease in patient hospitalization across all disease states, a 24 percent relative drop in discharges and a 7 percent drop in 30-day hospital readmissions after a seven-month period.

Based on these results, it stands to reason that equipping nurses specifically with an electronic medication learning resource with unbiased, succinct, well-researched content may have many positive outcomes for the hospital and the nurses themselves in today's healthcare environment.

There is a growing number of retiring nurses in the U.S., especially among baby boomer nurses who are leaving the profession at increasing rates. One 2016 survey from AMN Healthcare showed 62 percent of registered nurses over age 54 are considering retiring in the next three years. Hospitals are hiring younger nurses to fill the vacancies left by retiring nurses; however, those younger nurses have less experience than their older coworkers when it comes to earning practical experience in medication management.

"I think there is a gap between what nurses learn about pharmacology and theory in school and being able to apply it in a real situation," Dr. Kenny says. An electronic resource can especially "help young nurses in transition," she adds.

However, nurses of all ages can benefit from a current, unbiased medication learning resource like Nurse's Letter, as new medications are continually released. "I think nurses like reading it because we tackle the problems they encounter in day-to-day practice in a manner that's easy to digest," says Dr. Boehringer.

It can also serve to elevate the nursing profession as a whole, according to Dr. Kenny.

"This is a source truly dedicated to the professional practice of nursing," she explains. "So many items in a hospital are there for the infection control team, or the quality measures team, or physicians. Nurse's Letter is unique to nurses… Having a resource dedicated to nurses really elevates the presence of nursing."

Tools such as the Nurse's Letter empower nurses to provide the best care possible and elevate their presence in the hospital. These resources also have far-reaching implications for hospitals' bottom line in value-based care models, since medication management can positively affect so many metrics, like readmission rates, medication errors and medication-related adverse events and patient experience scores.

"Hospital leaders like Nurse's Letter because it provides nurses strategies to improve patient care and outcomes," she says. "It's helping them meet their hospital goals."

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