Improving HCAHPS Scores

Surrounding Medication
Administration
By: Angelita Honeycutt, Chelsea Dempsey, Emily
Settle, Jennifer Oliveri and Samantha Aitchison
Problem
When looking at HCAHPS data related to “Patients who reported that staff “always”
explained medicines before giving it to them,” MRMC scored 60% when compared to
Virginia’s average of 64%.
Macro and Micro Implications
● Macro: Insufficient patient medication education contributes to patient
dissatisfaction, adverse drug events, and financial implications (Gibson et al., 2017).
● Micro: When looking at HCAHPS data related to “Patients who reported that staff
“always” explained medicines before giving it to them,” MRMC scored 60% when
compared to Virginia’s average of 64%.
Reason for the Effort
● Every year, 4.3 million patients are
impacted by adverse drug events
and 70% of those errors are made at
the bedside (Gibson, et al., 2017).
● Reviewers of adverse events found
that more than 45% of medication
errors were preventable (Donaldson et al.,
2014).
AIM Statement

Our goal is to improve patient satisfaction regarding medication education

prior to administration at MRMC. Implementing specific interventions will
increase the hospital’s average by 4% to match Virginia’s average of 64%
within 6 months.
Analysis of the Issue
● Compared to the state average, there is lower patient reports of
education with medication administration at MRMC. We are looking at
nurse confidence levels and knowledge surrounding medication
education to improve these percentages.
● Based on the literature we have found that:
○ Nurses felt unprepared to teach, therefore lacked confidence in their
everyday nursing practice to provide patient medication education
○ Nurses need more clarification about the resources readily available
to them during medication administration
○ Patient safety regarding medication education is imperative to
positive patient outcomes
○ Collaboration with nursing and pharmacy is under-utilized
(Bowen et. al, 2017) (Prochnow et. al, 2019)
Data
● One possible contributing factor is that nurses may feel unprepared to
teach, therefore lacked confidence in their everyday nursing practice to
provide patient medication education

● The data we are looking at will be tracked by the resubmission of HCAHPS

surveys to show an increase in patient satisfaction regarding medication
education.
Data to Collect from Unit
When looking at the hospital data, we would ask staff nurses several
questions pertaining to medication administration:
● Do you provide medication education when administering medications?
Why or why not?
● Do you feel prepared with your knowledge on medication
pathophysiology and potential adverse effects?
● Do you have access to resources on your unit to help guide you in
providing the medication education?
● How long have you been a nurse?
● Do you feel the technology available helps you to provide this medication
education each time or does it impede this ability?
Root Cause
● We identified several factors that contribute to lower instances of
medication education during administration.

● At MRMC, we suspect the root cause could be lack of nurse confidence in

patient teaching and knowledge about medications.
 Proposed Solution

We predict that if we implement medication education, the nurses’ confidence

and knowledge will increase, therefore they will provide medication education
at a higher rate. Our goal is to increase the hospital’s average by 4% to mirror
Virginia’s average of 64%. We hope to have this accomplished by July 2021.
Proposed Solution

Quarterly Workday modules surrounding medication education

Logistics
● Training will be facilitated with the use of Workday modules on medication education
● There will be a total of 3 Workday modules with a duration of 1 hour each
● Each Workday module will contain learning checkpoints to ensure comprehension of the
information
● Nurses will have 30 days to complete these modules
● Barrier to change: Willingness to being educated
Stakeholders
● Nurses
● Management
● Clinical Care Leads
● Educators
● Patients
● Pharmacy
Potential Costs
● WorkDay Medication Education Module - Assume no cost 5-10 hour
development time and load to WorkDay- no fee to distribute
● 3 Modules - 1 hour of nurses time per module for a total of 3 hours of
nurses’ time.
○ Module 1- Education on the 5 most prescribed medications for unit population
○ Module 2- Education on the use of Micromedex
○ Module 3- Pharmacy Collaboration Education
Expected Benefits
Expected benefits include:

● Increased nursing knowledge resulting in enhanced confidence in

teaching medication administration resulting in positive patient outcomes

● Patient satisfaction in education of medication being administered

Timeline
● Proposal of Change - November 2020
● Module/Education Development - December 2020
● Release of 3 Workday modules: Medication education, Micromedex
education, and Pharmacy Collaboration education to be completed -
January 2021
● Measure of educational outcomes- June 2021
● Re-Measure - January 2022
Conclusion
● At MRMC, the changes we have
discussed will increase nurse
confidence with patient medication
education
● We expect that by implementing our
interventions, we can increase
patient satisfaction which will
increase MRMC Medication
Education HCAHPS scores from 60%
to 64%.
References
Bowen, J. F, Rotz, M.E, Patterson, B.J, Sen, S. (2017) Nurses’ attitudes and

behaviors on patient medication education. Pharmacy Practice. Retrieved

from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5499351/pdf /pharmpract-15-930.pdf

Donaldson, N., Aydin, C., Fridman, M., & Foley, M. (2014). Improving Medication Administration Safety:

Using Naïve Observation to Assess Practice and Guide Improvements in Process and Outcomes. Journal for

Healthcare Quality: Promoting Excellence in Healthcare, 36(6), 58–68. https://doi.org/10.1111/jhq.12090

Gibson, C. A., Stelter, A. J., Haglund, K. A., & Lerret, S. M. (2017). Pediatric

Nurses' Perspectives on Medication Teaching in a Children's Hospital.

https://www.sciencedirect.com/science/article/abs/pii/S0882596317301240

Goodwin, J., Kilty, C., Harman, M., & Horgan, A. (2019, June). "A great stress among students" - mental health nurses' views of medication

education: A qualitative descriptive study. Retrieved October 14, 2020, from https://www.ncbi.nlm.nih.gov/pubmed/30925342

Prochnow, J. A., Meiers, S.J., Scheckel, M.M. (2019). Improving patient and caregiver new medication education using an innovative teach-back

toolkit. Journal of Nursing Care Quality 34(2), 101-106. doi: 10.1097/NCQ.0000000000000342.

U.S. Centers for Medicare & Medicaid Services. (2020). Hospital compare: Memorial Regional Medical Center survey of patient experiences.

https://www.medicare.gov/hospitalcompare/profile.html#profTab=1&ID=490069&loc=MECHANICSVILLE%2C%20VA&lat=37.6087561&lng=-77.3733139&name=Memo

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