TL3EO
Advocacy and Influence TL3EO
Using the required empirical outcomes (EO) presentation format, provide one example of an improved patient outcome that aligns with a goal in the nursing strategic plan.
- Provide a copy of the related nursing strategic plan.
Example: Improving Communication about Medications on 5 East
Problem
The 5 East (5E) Orthopedics/Neurosurgery unit at Catholic Health Initiatives (CHI) St. Vincent Hot Springs (SVHS) had lower patient experience scores, related to communication about medications in September 2022.
Pre-Intervention
Barbara Erby-Ellis, MSN, RN, Nurse Manager, collaborated with Sarah Ostrem, BSN, RN, CMSRN, Clinical Nurse, to take this issue to the 5E Unit-Based Council (UBC) to develop tactics with the other clinical nurses to increase the 5E Press Ganey (PG) Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Top Box percent score for communication about medications, which was lower than expected at 57.69% in September 2022.
Erby-Ellis and Ostrem’s plan aligned with a goal in the CHI SVHS FY2021 to FY2025 nursing strategic plan in the Growth theme. The Growth theme is about “serving more people by growing the ministry for long-term viability.” The goal associated with the Growth theme is to “encourage and promote innovation to improve/redesign patient outcomes, patient experience, and practice environment to improve and grow our ministry.”
The goal measurement in the plan is to increase the overall rating of the hospital with patient experience scores, related to communication about medications. The CHI SVHS nursing initiatives contributing to this metric are bedside shift reports, nurse leader rounding, leader rounding, Meds to Beds, and multidisciplinary rounding. (Evidence TL3EO-1, FY21 to FY25 Nursing Strategic Plan, page 14)
Goal Statement
Improve PG HCAHPS Top Box percent score for communication about medications on 5E.
Participants
5E Communication about Medications Workgroup
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Name/Credentials |
Discipline |
Title/Role |
Department |
Barbara Erby-Ellis, MSN, RN |
Nursing |
Nurse Manager |
5 East |
Sarah Ostrem, BSN, |
Nursing |
Clinical Nurse |
5 East |
Kaitlyn Atkins, MSN, |
Nursing |
Clinical Director of |
Nursing |
Stephanie Bailey, LPN |
Nursing |
Supervisor of Discharge Transition |
Patient Relations |
Robbie Loudermilk, |
Patient Relations |
Service Excellence |
Patient Relations |
Description of the Intervention October 2022
Ostrem led the 5E UBC on how to improve Press Ganey HCAHPS Top Box scores for communication about medications:
- Ostrem presented the idea of adding labels to the communication boards for new medications and side effects. Communication boards allow for the frontline nurse to communicate and teach the patient and family about the medication and related side effects. The information on the communication boards allows for all nurses during direct patient care, including bedside shift reports, nurse leader rounding, and leader rounding to complete education on medication side effects. The teach-back method is then used to ensure patients can retain information. This initiative is aligned with the goal of the nursing strategic plan to improve communication about medications.
- The UBC, including clinical nurses, discussed the need to increase the number of patients who use Meds to Beds to ensure the patients received education about the side effects of medications from a pharmacist before discharge. Meds to Beds is a program offered in collaboration with Smith Pharmacy and compounding. This evidence-based practice initiative is proven to improve patient outcomes by reducing readmissions and the length of stay and ensuring patients understand the importance of taking their medications. If patients elect the service, any prescriptions are delivered directly to the patient’s bedside at discharge and the patient is educated on the medication and its side effects. This initiative is aligned with the goal of the nursing strategic plan to improve communication about medications.
- CommonSpirit Health, the overarching organization for CHI SVHS, implemented the use of a new medication emoji sheet that was placed in each patient room. The medication sheets include commonly used medications and side effects and an emoji to correlate with the side effects. 5E UBC adopted the use of the new sheets. This change is aligned with the goal of the nursing strategic plan to improve communication about medications and MDR.
November 2022
- Communication labels were added to each communication board. Communication labels enhance the evidence-based teach-back practice initiative to improve patient education. The communication labels are a visual queue for nurses to discuss patient medication education needs during bedside shift reports and medication administration. This change is aligned with the goal of the nursing strategic plan to improve communication about medications.
- The 5E UBC clinical nurses edited the multidisciplinary rounding (MDR) forms. Meds to Beds and the new form were implemented and used during MDR for every patient on 5E. This change is aligned with the goal of the nursing strategic plan to improve communication about medications.
The interventions were fully implemented by the end of November 2022.
The communication board labels, increasing Meds to Beds, a new medication emoji sheet, and updating the MDR form interventions improved the outcome of communication about medications. The improvement in top box percent scores is aligned with a goal in the FY21 to FY25 nursing strategic plan.
References
Katz, D. T., Fernandez-Sanchez, J. V., Loeffler, L. A., Chang, S. M., Puertolas-Lopez, M. V., Ramdial, F. R., Fisher, G. R., Gutierrez, S. A., Mahajan, N., Keerthy, D. R., Cavallaro, S. P., Landaeta, C. E., Pascall, A. S., Acevedo, K. T., Chan-Poon, K. T., Abraham, B. R., Siri, M., Reynolds, K. L., Van Kirk, K., & Bayes Santos, L. Y. (2020). Timely delivery of discharge medications to patients’ bedsides: A patient-centered quality improvement project. Pediatric Quality & Safety, 5(3). https://doi.org/10.1097/pq9.0000000000000297
Teach-back. AHRQ. (n.d.-a). https://www.ahrq.gov/patient-safety/reports/engage/interventions/teachback.html
Outcome