July 2015
Swank Health: Your monthly news from Swank HealthCare

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Did You Know?

Improving Medication Adherence Post-discharge

Top List
What's Going On?

Navigating the road to accreditation
Top Challenges Faced by Nursing Executives

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Take this quick quiz on medication adherence and see how well you score.

Recommended Readings

Recommended Courses*
  • 61215 Geriatrics: Addressing Medication-related Problems in the Elderly
  • 316314/611814 Improving Medication Adherence and Decreasing Risk of Polypharmacy
  • 63215 Geriatric Medication Management
  • 71114 Medication Use Evaluation: YOU Can Shift the Paradigm

* course numbers may vary by facility

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Did You Know?

Improving Medication Adherence Post-discharge

Did you know that about 20% of hospital discharged patients experience an adverse event after discharge, and of those, about two-thirds are related to medications? In fact, more post-discharge adverse events are related to drugs than any other cause. One study found that about 33% of hospital admissions related to drug events were caused by a lack of adherence. Medication non-adherence is defined as a dose or doses not taken or taken incorrectly that jeopardize a patient’s therapeutic outcome. It can take a variety of forms, such as not having a prescription filled, taking an incorrect dose, taking a drug at the wrong time, forgetting to take a dose, improper administration or stopping therapy too soon.

What are the causes of medication non-adherence?

Today, patients have greater numbers of chronic conditions, which are frequently managed by a number of different specialists, meaning they often take multiple medications prescribed by multiple doctors. Added to that mix, hospitalized patients are now more likely to be treated by hospitalists rather than their primary care physician. This can create confusion for patients about what drugs to take.

A greater number of chronic conditions mean that greater numbers of medications are often prescribed for a single patient. For some patients, this can make it difficult to afford purchasing all prescribed medications. They may feel they have to choose which prescriptions to fill and which ones to leave unfilled. In other cases, patients may take partial doses in an effort to prolong prescription refills.

Reductions in hospital length of stay often leave discharged patients in need of assistance in getting medications from a pharmacy, and/or administering them correctly. Without proper assistance, prescriptions are sometimes left unfilled or may be taken incorrectly.

Several medical conditions require patients to monitor a variety of health indicators, such as weight, blood sugar, and vital signs and then adjust medications according to prescribed parameters. Low health literacy or cognitive ability can create challenges for proper monitoring and appropriate medication adjustments, especially when co-morbidities exist.

Non-adherence can occur when patients aren’t adequately educated about the importance of taking prescribed medications, how to administer them, when to start and stop therapy and the risks of non-adherence.

When a patient takes a medication prior to hospitalization that he or she knows only by, either the brand or generic name (but not both), and medication instructions post-discharge list the same drug to be taken by the form not known, it can lead to the belief that they are two different medications. This can lead to dangerous outcomes when doses of the same drug are inadvertently doubled.

Religious, cultural and ethnic beliefs can also impact medication adherence. Members of the Jehovah’s Witness faith may prefer to abstain from prescription drugs. Those of the Jewish faith may prefer alternatives to medications that contain non-kosher products, such as pork. Other preferences sometimes based on religious, spiritual or cultural beliefs that can impact adherence include: the use of herbal medicine, folk remedies or spiritual healers in lieu of prescription drugs; abstaining from the use of contraceptives or medications to treat mental illness.

Other factors that sometimes contribute to medication non-adherence are, visual impairments that can make it difficult to read drug labels and measurements, and physical impairments that hinder proper drug administration.

What's Going On?

Navigating the road to accreditation:

With the state of Georgia implementing new regulations on continuing education requirements for nurses, Swank HealthCare has everything you need to meet these requirements by 2016!

More Information »

Top Challenges Faced by Nursing Executives:

Swank HealthCare recently took a poll, asking nurse executives what challenges they face in their daily work routine.

More Information »

Recommended Readings

Top List

Proper preparation is key to helping patients improve medication adherence after discharge. Here are the top 10 strategies.

  1. Perform medication reconciliation. The first, and possibly most important step in improving medication adherence is compiling an accurate list of medications the patient was taking prior to admission, during hospitalization, and what he or she is to take after discharge. This forms the basis for informing the patient of which drugs to continue, which ones should be discontinued, doses that have been changed and new drugs to begin taking.
  2. Educate about each medication’s purpose and risks of non-compliance. When patients understand how medications help improve their health and what can happen if they don’t take them as prescribed, they’re more likely to adhere. Be sure to include an interpreter if the patient prefers to communicate in a language other than English.
  3. Educate about proper drug administration. This should include:
    1. Clear instructions about drug administration
    2. What to do if a dose is missed
    3. When and under what conditions a medication should and should not be taken
    4. What side effects or other health conditions to watch out for and what to do if they occur
    5. Who to call if questions or concerns arise. Include phone numbers
  4. Include simple, written instructions for all medications to be taken after discharge. Be sure to include the generic and brand names, dose, frequency, when to start and stop therapy, and any special instructions. Make sure instructions are legible, are in a size easy for patients with limited vision to read, include only basic non-medical terminology, and avoid the use of abbreviations.
  5. Use Teach-back. The best way to assess patients’ understanding of medication instructions is to ask them to teach-back or restate the information in their own words: “To make sure I didn’t leave anything out, tell me about how to take your insulin.”
  6. Include the patient’s family or caregiver in education. Once patients are home after discharge, they sometimes report not remembering all the instructions about what drugs they should take and how to administer them. Family members and caregivers can help when they’re also informed.
  7. Ensure timely follow-up. Ideally, patients should follow-up with their primary care provider within seven days of discharge. Stress the importance of taking all medications to the appointment. Depending on the patient’s condition, risk for non-adherence and other factors, a more timely follow-up visit or phone call may be needed to monitor medication use and adherence.
  8. Ask the patient about any reasons he or she might not fill prescriptions. Unless patients are specifically asked, they may not report concerns about filling prescriptions. Make sure they have adequate transportation and the ability to pay. If concerns are reported, seek assistance from a social worker or care manager prior to discharge.
  9. Ask patients about any religious or spiritual beliefs that could impact medication preferences. In addition to reasons a prescription might not be filled, patients may not report religious or spiritual beliefs that may impact their willingness to comply with prescribed medications. It’s important to avoid judgments or criticism, but if concerns are reported, speak with the prescribing physician about possible alternatives.
  10. Encourage the use of medication reminders. Pill boxes with slots for different times of the day can be filled up to a week in advance. Reminder alarms can range from a watch with alarms that sound when it’s time to take a medication to computer software that includes specific medication information.

Now Trending

Take this quick quiz on medication adherence and see how well you score.

How many deaths in the U.S. are caused by medication non-adherence each year?

A. 10,000
B. 40,000
C. 125,000
D. 250,000

Which patient population is NOT at increased risk for medication non-adherence and 30-day hospital readmission?

A. Patients with a history of substance abuse
B. Patients with chronic conditions
C. Patients with psychiatric disabilities
D. Patients with low overall satisfaction with care

Which of the following is NOT a factor that affects medication adherence?

A. trust in healthcare providers
B. patient’s gender
C. complexity of medication regimen
D. English language proficiency

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Answer: C – 125,000


Answer: D. Patients with low overall satisfaction with care


Answer: B. patient’s gender