ihi expedition expedition expedition: improving medication safety from the patient’s perspective...
TRANSCRIPT
IHI ExpeditionExpedition: Improving Medication Safety from the Patient’s Perspective
Session 2: Health Literacy and Medication Safety
March 12, 2015
These presenters have
nothing to disclose
Gail A. Nielsen, BSHCA, FAHRAFrank Federico, RPhJoelle Baehrend
Today’s Host2
Dorian BurksProject Coordinator
Institute for Healthcare Improvement
Phone Connection (Preferred)3
To join by phone:1) Click on the
“Participants” and “Chat” icons in the top right hand side of your
screen. 2) Click the button
on the right hand side of
the screen.3) A pop-up box will
appear with the option “I
will call in.” Click that option.
4) Please dial the phone
number, the event number and your attendee ID to connect
correctly .
WebEx Quick Reference
• Please use chat to
“All Participants”
for questions
• For technology
issues only, please
chat to “Host”
4
Enter Text
Select Chat recipient
Raise your hand
5
When Chatting…
Please send your message to
All Participants
Expedition Director6
Joelle Baehrend
Director
Institute for Healthcare Improvement
Today’s Agenda7
• Welcome & Introductions
• Action Period Debrief
• Health Literacy and Medication Safety
– Gail Nielsen, BSHCA, FAHRA
• Action Period Assignment
Expedition Sessions
Session 1 – Improving PolypharmacyFaculty : Robert Feroli, PharmD and Amanda Brummel, PharmD, BCACP
Session 2 – Health Literacy and Medication SafetyFaculty : Gail Nielsen, BSHCA, FAHRA
Session 3 – Improving Medication AdherenceFaculty : William Strull, MD
Session 4 – Medication ReconciliationFaculty : Anne Myrka, RPh, MAT
Session 5 – Safe Management of Newly Released Anticoagulants and High-Alert
MedicationsFaculty : L. Hayley Burgess, PharmD
8
Action Period Assignment – Report Out
Research and consider what your facility has in
place to optimize medication use and minimize
polypharmacy.
Please use the chat to share:
– What did you learn about your organization’s process
for medication therapy management and efforts to
reduce polypharmacy where appropriate?
– Any surprises?
Survey Results - Current State
Health Literacy: My hospital has a process for assessing
patients’ ability to understand instructions related to their
medications.
• Do not know current status of this practice: 10%
• Do not currently have this practice in place: 10%
• Have a process that supports this practice: 30%
• Process is reliably applied: 30%
• Need further clarification on this practice: 20%
10
Faculty11
Frank Federico, RPhExecutive Director, Strategic Partners
Institute for Healthcare Improvement
Faculty12
Gail A. Nielsen, BSHCA, FAHRAFellow & Patient Safety Scholar
Institute for Healthcare Improvement
Health Literacy Impact on Medication SafetyGail Nielsen
These presenters have
nothing to disclose
March 12, 2015
Objectives
• Describe the impact of health literacy on
medication safety
• List two ideas for using health literacy
principles and techniques to increase
medication safety
Health Literacy
“The degree to which individuals have the
capacity to obtain, process, and
understand basic health information and
services needed to make appropriate
health decisions.”
Impact of Literacy and Health Literacy
Lower health literacy is associated with poorer health outcomes, worse health status, less health knowledge, and
worse disease control
Literacy is a stronger predictor of worse outcomes than age, income, employment status, educational level or racial or
ethnic group
Better health literacy is associated with a lower prevalence of diabetes
Baker DW, Gazmararian JA, Williams MV, et al. Functional health literacy and the risk of hospital admission among medicare managed care enrollees. Am J of Public Health. 2002;92(8):1278-83
Schillinger D, Grumbach K, Piette J, et al. Association of health literacy with diabetes outcomes. JAMA. 2002;288(4):475-82
Schillinger D, et al. Closing the loop: physician communication with diabetic patients who have low health
literacy. Arch Intern Med. 2003;163(1):83–90.
Health Literacy:
Impact on Medication Safety
Med errors and adverse drug events
Unrealistic optimism of patient and family to manage
self-care and medications
Patient lack of adherence to do self-care e.g., take
medications, because of:
– Poor understanding or confusion about how to use, access, or
pay for medications
– Self-care instructions that are confusing, contradictory to other
instructions, or are not tailored to a patient’s level of health
literacy
– Medication discrepancies in handover information
Post-discharge Complications
ADEs account for 2/3s of post-
discharge complications occurring
within 3 weeks of hospital
discharge
24% were judged preventable [1]
In a similar study, 27% were judged
preventable; 33% ameliorable [2].
http://www.health.gov/hai/pdfs/ADE-Action-Plan-508c.pdf
1. Cook CB, Kongable GL, Potter DJ, Abad VJ, Leija DE, Anderson M. Inpatient glucose control: a glycemic
survey of 126 U.S. hospitals. J Hosp Med. 2009;4(9):E7-E14.
2. Nirantharakumar K, Marshall T, Hodson J, Narendran P, Deeks J, Coleman JJ, et al. Hypoglycemia in non-
diabetic in-patients: clinical or criminal?. PLoS ONE. 2012;7(7):e40384.
Changing Paradigms
Traditional Focus Transformational Focus
Clinician teaching What are the patient and
family caregivers learning?
Patients are the recipients
of care and the focus of
the care team
Patient and family members
are essential and active
members of the care team
Two ideas for using health literacy principles
and techniques to increase medication safety
Always Use Teach-back!
Develop consistency of teaching content
across the continuum
Helping Patients Understand
Assess patient’s ability to
understand how to:
Do critical self-care
activities - taking
medications
Access care needs related
to medications
Use Teach-back
• Explain needed information to the patient or family
caregiver
• Ask in a non-shaming way for the individual to say
in his or her own words what was understood
Example: “I want to be sure that I did a good job of
teaching you today about how to take this new
medication. Could you please tell me in your own
words how you will take it at home?”
Augmenting Teach-back
Patients and families often don’t know
what questions to ask
To discover potential opportunities for
intervention, ask:
– What will be hard about taking this medicine?
– What worries you about taking your medications?
– Have we missed anything?
– Who helps you with your medications?
Using Teach-back Reliably
Requires:
Developing user competence
and
Building the daily habit
Helping Patients Understand
Meds administration by non-pharmacy staff
Patient teaching around taking medications
Using patient-friendly language and techniques
Using competence and habits for teach-back
Assess process reliability through observations:
10 Elements of Competence for Using
Teach-back Effectively
1. Use a caring tone of voice and attitude
2. Display comfortable body language and make eye contact
3. Use plain language4. Ask the patient to explain back, using their own words
5. Use non-shaming, open-ended questions
6. Avoid asking questions that can be answered with a simple yes or no
7. Emphasize the responsibility to explain clearly is on you, the provider
8. If the patient is not able to teach back correctly, explain again and re-check
9. Use reader-friendly print materials to support learning10. Document use of and patient response to Teach-back
www.teachbacktraining.com
27
www.teachbacktraining.com
Hospital
Primary & Specialty Care
Home Health Care Home (Patient & Family Caregivers)
How Might We……..?
…use the same core content and teaching
materials in all community patient care settings?
Rutherford P, Nielsen GA, Taylor J, Bradke P, Coleman E. How-to Guide: Improving Transitions from the Hospital to Community Settings to Reduce Avoidable Rehospitalizations. Cambridge, MA: Institute for Healthcare Improvement; June 2013. Available at www.IHI.org.
Resources
AHRQ Health Literacy Tools
for Use in Pharmacies
Pharmacy Health Literacy Assessment Tool & User's
Guide
Training program for pharmacy staff on communication
Guide on how-to create a pill card
Telephone reminder tool to help refill medicines on time
Explicit and standardized prescription medicine
instructions
http://www.ahrq.gov/professionals/quality-patient-safety/pharmhealthlit/tools.html
Improve Communication
Health Literacy linked to misunderstanding instructions about prescription medication errors…
ACTION:
• Target and Tailor Communication
• Make Organizational Changes
http://www.health.gov/communication/hlactionplan/pdf/Health_Literacy_Action_Plan.pdf
Linking limited health literacy to misunderstanding
instructions about prescription medication, medication errors,
poor comprehension of nutrition labels, and mortality:
• Davis, T. C., Wolf, M. S., Bass, P. F. III, Middlebrooks, M., Kennen, E., Baker, D. W., et al.
(2006). Low literacy impairs comprehension of prescription drug warning labels. Journal of
General Internal Medicine, 21(8), 847–851.
• Davis, T. C., Wolf, M. S., Bass, P. F. III, Thompson, J. A., Tilson, H. H., Neuberger, M., et
al. (2006). Literacy and misunderstanding prescription drug labels. Annals of Internal
Medicine, 145(12), 887– 894.
• Rothman, R. L., Housam, R., Weiss, H., Davis, D., Gregory, R., Gebretsadik, T., et al.
(2006). Patient understanding of food labels: The role of literacy and numeracy. American
Journal of Preventive Medicine, 31(5), 391–398.
• Wolf, M. S., Davis, T. S., Tilson, H. H., Bass, P. F., & Parker, R. M. (2006).
Misunderstanding of prescription drug warning labels among patients with low literacy.
American Journal of HealthSystem Pharmacy, 63, 1048–1055.
• Baker, D. W., Wolf, M. S., Feinglass, J., & Thompson, J. A. (2008). Health literacy,
cognitive abilities, and mortality among elderly persons. Journal of General Internal
Medicine, 23(6), 723–726.
• Juzych, M. S., Randhawa, S., Shukairy, A., Kaushal, P., Gupta, A., & Shalauta, N. (2008).
Functional health literacy in patients with glaucoma in urban settings. Archives of
Ophthalmology, 126(5), 718–724
http://www.health.gov/communication/hlactionplan/pdf/Health_Literacy_Action_Plan.pdf
Creating standards and guidelines to improve the
communication of information on prescription labels
The United States Pharmacopeia and the National
Association of Boards of Pharmacy both have initiatives to
create standards and guidelines to improve the
communication of information on prescription labels.
National Association of Boards of Pharmacy. (2009,
February). Report of the Task Force on Uniform Prescription
Labeling Requirements. Mount Prospect, IL: Author.
U.S. Pharmacopeia. (2009). 2008 Health literacy and
prescription container labeling advisory panel: Meeting 2. Rockville, MD: U.S. Pharmacopeia.
http://www.health.gov/communication/hlactionplan/pdf/Health_Literacy_Action_Plan.pdf
Taking Action: 3 High-Risk Drugs
http://www.health.gov/hai/pdfs/ADE-Action-Plan-508c.pdf
Initial targets of the ADE Action Plan:
• Anticoagulants
• Diabetes agents
• Opioids
Approach to reduce patient harms from these three ADEs:
• Surveillance
• Prevention
• Incentives and Oversight
• Research
http://iom.edu/Activities/PublicHealth/HealthLiteracy/2014-MAR-
17.aspx?utm_medium=etmail&utm_source=Institute%20of%20Medicine&u
tm_campaign=03.17.14+Health+Lit+webcast&utm_content=&utm_term
35
Roundtable on Health LiteracyBoard on Population Health and Public Health Practice
Questions/Discussion36
Raise your hand
Use the chat
Action Period Assignment:
Review your organization’s patient literature for three
medications and ask patients to read it and provide
feedback on understanding of content
– Please be prepared to share on our next session
Expedition Communications
• All sessions are recorded
• Materials are sent one day in advance
• Listserv address for session communications:
• To add colleagues, email us at [email protected]
38
Session 3
William Strull, MDMedical Director for Quality and Patient Safety
The Permanente Foundation
39
Thursday, March 26th, 1:00 – 2:00 PM ET
Improving Medication Adherence
Thank You!40
Joelle Baehrend
Dorian Burks
Please let us know if you have any questions or
feedback following today’s Expedition webinar.