Background: The Center for Health Literacy, at the University of Arkansas for Medical Science, reports that 37% of adults in Arkansas have poor health literacy and this is linked to a greater number of hospitalizations, patients incorrectly taking their medications, and overall poorer total health outcomes. Teaching inpatients about their medications and potential side effects is an established nursing responsibility and the medical-surgical unit chosen for this Doctor of Nursing Practice (DNP) project had low medication communication scores on the 2016 Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. This project supported the nursing staff by introducing the Transforming Care at the Bedside (TCAB) framework and Teach-back Tool #5 of the Health Literacy Universal Precautions Toolkit to facilitate a rapid change to improve the Top-box score on the HCAHPS survey for medication communication.
Purpose: The purpose of this pilot study was threefold. The first was to examine whether inpatients at a Southeast Arkansas hospital better understand their new medications when bedside nurses use a teach-back modality compared with the usual medication education method. The second was to investigate the impact of the teach-back method on HCAHPS survey Top-box medication communication scores and patient satisfaction. The third was to expand upon/replicate Gillam et al. (2016) innovative teach-back medication education program at a hospital in Southeast Arkansas.
Objectives:
- Increase the HCAHPS survey quarterly hospital data with clear nurse-patient medication communication by 25%. HCAHPS questions #16, 17, and 25 were examined where survey numbers 16 and 17 measured new medication(s) and 25 measured medication(s) knowledge recall post-discharge.
- Obtain a 70% increase improvement for inpatient knowledge on new medication(s) (dosage, side effects, purpose, and schedule) after being exposed to the MED-KUP™ program, on the Pretest/Posttest MED-KUP™ instrument.
- Require that 100% of the volunteer nurses achieve a competency grade of 11/11 post teach-back training session on the “Teach-back Observation Tool”.
- Require that 80% of the volunteer nurses report being confident in the ability to use teach-back at a level of 6 or higher; and being convinced it is important to use Teach-back at a level of 6 or higher on the “Conviction and Confidence Scale” after one month of implementing the teach-back MED-KUP™ program.
Clinical Question: For a rural midsized hospital can a TCAB nurse-patient communication intervention compared to usual nurse-patient communication improve inpatient satisfaction with medication education as measured by the HCAHPS survey Top-box medication communication score?
Methods: The pilot study used a cross-sectional one-group pretest posttest design between September to December 2017, at a Southeast Arkansas hospital, where 50 patient participants completed the MED-KUP™ medication education program. Data collection instruments used were the HCAHPS survey (Cronbach Alpha >.80), Tool#5 of the Health Literacy Universal Precautions Toolkit and MED-KUP™ Questionnaire Data Entry Form.
Theoretical Framework and Models: Two frameworks were chosen for this DNP capstone project. First, the Institute of Healthcare Improvement (IHI) New Idealized Design was utilized to provide guidance and structure when implementing the Transforming Care at the Bedside MED-KUP™ intervention. Second, the teach-back method is a patient-centered teaching technique that promoted a two-way dialogue between the patient and nurse. This teach-back method involved assessing, repeating, clarifying/modifying and reassessing patient comprehension and understanding.
Results:
Objective 1 Findings: Percentage point changes were calculated by subtracting previous quarter scores from the 2017 fourth quarter scores. Even though there was a positive trend for HCAHPS Questions 16, 17 & 25, only #17 (Quarter 3, 2017) exceeded the benchmark with a percentage point increase of 35.
Objective 2 Findings: The Wilcoxin Signed-Ranks Test was significantly higher after the MED-KUP medication education program (Mdn = 4) than before the program (Mdn = 1), Z = 6.218, p <.01. Objective was met with a 1.5 percentage point increase above benchmark of 70%.
Objective 3 Findings: 100% of the volunteer nurses achieved a competency grade of 100% on the “Teach-back Observation Tool©”.
Objective 4 Findings: 100% of the volunteer nurses reported “confidence” and “convinced” levels above the benchmark of 6.
Recommendations: This DNP student advocates for nurse entrepreneurship and the MED-KUP program should be commercialized by marketing this unique program to hospitals who have low HCAHPS patient satisfaction scores for medication communication.
See more of: Oral Paper & Poster: Clinical Sessions