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The Impact of Daily Medication Lists Given to Hospitalized Patients

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Title:
The Impact of Daily Medication Lists Given to Hospitalized Patients
Creator:
Herbenick, Sara
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English

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Subjects / Keywords:
Control groups ( jstor )
Control units ( jstor )
Health care industry ( jstor )
Hospitals ( jstor )
Internships ( jstor )
Medical errors ( jstor )
Medication errors ( jstor )
Medications ( jstor )
Nurses ( jstor )
Patient care ( jstor )
Medication errors
Patients
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Undergraduate Honors Thesis

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Abstract:
The purpose of this study is to examine the effects a daily medication list given to patients in the hospital has on patient reported medication errors, patient involvement in their medical care, and patient satisfaction with their inpatient medication management. A quasi-experimental design was implemented on two similar adult medicine units at Shands at the University of Florida. Two hundred adult participants were recruited; the experimental group (n=100) comprised of patients from the intervention unit who received a daily medication list and subsequent follow-up interviews, and the control group (n=100) comprised of patients from the control unit. Preliminary findings showed 82.4% of participants who received a daily medication list found the list to be useful and 27.3% of these participants reported a medication concern on day 1 of the follow-up interviews. 70.6% of the experimental group asked questions regarding their medications, compared to 50.9% of control group participants. The results indicate that the medication list was helpful in improving communication between patient and providers, making the patient more incline to ask questions and speak up regarding errors. Future implications include instituting the daily medication list throughout Shands as a part of the role of the registered nurse. ( en )
General Note:
Awarded Bachelor of Science in Nursing; Graduated May 7, 2013 magna cum laude. Major: Nursing
General Note:
Advisor: Dr. Donna Neff
General Note:
College/School: College of Nursing
General Note:
Legacy honors title: Only abstract available from former Honors Program sponsored database.

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University of Florida
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University of Florida
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Copyright Sara Herbenick. Permission granted to the University of Florida to digitize, archive and distribute this item for non-profit research and educational purposes. Any reuse of this item in excess of fair use or other copyright exemptions requires permission of the copyright holder.

Full Text

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1 Running head: THE IMPACT OF DAILY MEDICATION LISTS GIVEN TO HOSPITALIZED PATIENTS The Impact of Daily Medication Lists Given to Hospitalized Patients Sara Herbenick University of Florida

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2 THE IMPACT OF DAILY MEDICATION LISTS GIVEN TO HOSPITALIZED PATIENTS Abstract The purpose of this study is to examine the effects a daily medication list given to patients in the hospital has on patient reported medication errors, patient involvement in their medical care, and patient satisfaction with their inpatient medication man agement. A quasi experimental design was implemented on two similar adult medicine units at Shands at the University of Florida. Two hundred adult participants were recruited; the experimental group (n=100) comprised of patients from the intervention unit who received a daily medication list and subsequent follow up interviews, and the control group (n=100) comprised of patients from the control unit. Preliminary findings showed 82.4% of participants who received a daily medication list found the list to be useful and 27.3% of these participants reported a medication concern on day 1 of the follow up interviews. 70.6% of the experimental group asked questions regarding their medications, compared to 50.9% of control group participants. The results indicate t hat the medication list was helpful in improving communication between patient and providers, making the patient more incline to ask questions and speak up regarding errors. Future implications include instituting the daily medication list throughout Shand s as a part of the role of the registered nurse. Keywords : medication error, medication list, patient satisfaction, safety, patient confidence

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3 THE IMPACT OF DAILY MEDICATION LISTS GIVEN TO HOSPITALIZED PATIENTS The Impact of Daily Medication Lists Given to Hospitalized Patients Background/Significance Medical errors occur in all aspects of care and research has shown that 17% of patients have revealed experiencing an error while in the hospital with 44% of the errors related to medication s (Burroughs Waterman, Gallagher, Jeffele, Dunagan, & Fraseraser, 2007 ). In most instances, medication errors are identified and reported by health care providers and the patients are known to take a less active role in their medical care when in the hospital. There are many factors that contribute to this lack of willingness to parti cipate including socio economic factors, cognitive aspects, the hospital setting itself, and a large aspect being the relationship between patient and provider. Common themes of miscommunication between the clinician and patient, a fear of judgment by the healthcare provider, or a providers lack of ability to communicate so that a patient may understand are just a few of the faults know n to be associated with patient engagement with the healthcare team (Doherty & Stavropoulou, 2012). A complaint congruent with the ineffective patient provider interaction is that providers do not take the time to explain communication, and self & Cronenwett, 2006). In 2002 the Joint Commission addressed this issue by creating the Speak Up Campaign urging patients to take become more involved in their healthcare with the hopes that their participation will reduce the risk of medical errors. The free brochures, posters, and videos used to inform patients about the importance of involvement in their care has shown success with strengthening communication between healthcare providers and patients regarding safety ( The Joint Commission, 2012)

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4 THE IMPACT OF DAILY MEDICATION LISTS GIVEN TO HOSPITALIZED PATIENTS Purpo se The Speak Up Campaign sparked a hypothesis that if patients in the hospital were to receive daily lists of their medications that they would be more prone to participate in their care and speak up about potential errors before they occur. Thus, a pilot study was conducted in 2011 testing this hypothesis by implementing a daily medication list to participants on an adult medicine unit at Shands at the University of Florida. The results indicated that patients not only found the list helpful, but receivin g the list encouraged patients to report medical errors. The study coordinators wanted to expand this study onto two large medicine units at Shands to compare the impacts of participants receiving a list to not receiving a list. Th is study aims to determine the impact patients receiving a daily medication list would have on the reporting of more satisfied with their medication management when using the list as a tool. Methods The study was based off of the pilot study conduct ed in 2011. The pilot study was executed on a single medicine unit and so this study was broadened to include t w o large medicine units to note if there were differences in the responses of those who received a daily list on one unit, compared to those on the other unit that did not. The study design is quasi experimental, which encompasses the use of convenience sampling of the target population and lacks the design aspec t of random assignment. The participants sought after had to be at least 18 years of age and patients admitted to Shands at UF on units 74 and 75. The exclusion criteria included patients who were cognitively impaired, unconscious, non English speaking, an d/or unable to read. The target population is broken into two groups depending on the unit the

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5 THE IMPACT OF DAILY MEDICATION LISTS GIVEN TO HOSPITALIZED PATIENTS participant is located. Unit 74 comprised the intervention group who is receiving a daily medication list and unit 75 participants make up the control group who are not receiving any treatment Intervention On the intervention unit the nurse was to ask each of their patients if they would like to receive a daily printout of a list of their medications. To identify p atients to include in the study, the research interns would see th e charge nurse to obtain a list of patients who were newly admitted on to the unit. After reviewing the i nclusion and exclusion criteria the intern must giver, for instance the nurse, and ask if he/she would b e willing to informed consent and briefly explain the study. Following the explanation, the intern would conduct the daily patient survey questionnaire to identify if the patients had an y issues with their medications or noticed any errors (see Appendix A) If the patient had any concerns the intern was to go address the issue with the caregiver, as well as the pharmacist if need be. For each consecutive day the part icipant would receive a daily list of their medications printed out by the nurse. The daily follow up interview is asked for subsequent days with a goal of obtaining a daily survey for 5 days. On the 5 th day or the day of discharge a final day satisfaction survey is adm inistered (see Appendix B C, & D). A key criterion to note is that patients were not discharged prior to the first follow longer included in the study. Control

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6 THE IMPACT OF DAILY MEDICATION LISTS GIVEN TO HOSPITALIZED PATIENTS The participants on the control unit were not receiving a daily list of their medications and therefore were not administe re d a daily follow up survey. Similarly to identify ing patients on the intervention unit, the intern went to the char ge nurse to obtai n a list of the patients and review to see which patients fit the inclusion criteria. It is important to recognize that the patients asked to participate on the control unit are patients who are anticip ating discharge within 24 hours. After going through t he same process of obtaining informed co nsent, the research intern then administered the final day satisfaction survey. The second page of the survey regarding if the participant found the list to be useful was omitted. Procedure In order to protect the health info rmation of all the participants each subject was given a number that corresponded to their medical record number. This way when documenting data for analysis the subject number was used and only the research team knew the method to linking the two numbers All information was documented by the research interns into RedCap. RedCap is an online application to manage surveys tha t is password protected so that only those who are part of the research team can access the data. All of the data collected is only available on a password protected, encrypted computer. Once data collection has reached the goal sample size of 200 particip ants information can be gathered to conduct statistical analysis through descriptive statistics of proportions and means with standard deviations. Also, to compare the difference in the data of the intervention and control unit chi squares and nonparametr ic tests will be formulated. Student Research Intern Role

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7 THE IMPACT OF DAILY MEDICATION LISTS GIVEN TO HOSPITALIZED PATIENTS The role as the student research intern permitted the opportunity to work on every step in the process of this stu dy. R esponsibilities cover the entire scope of what was listed previously as far as identifying and consenting participants, conducting the interview questionnaires documenting all information into RedCap, and analyzing the data being collected. An extensive r eview of the literature was performed as well to determine how the study compared to other published findings of the same context. Anothe r important component as the research intern was after conducting the daily interviews with the intervention patients r eporting any concerns to the caregiver A report by the Institute of Medicine (2006) researched the prevalence of medication errors and formulated a national agenda to reduce such adverse events. F indings estimated 380,000 preventable errors occur in hospi tals each year and so the committee began looking at ways of creating a new healthcare model that is less provider centered and more focused upon creating a partnership between patients and providers. The following was reported : T o make thi s new model of health care work, a number of things must be done. D octors, nurses, pharmacists and other providers must communicate more with patients at every step of the way and make that communication a two way street, listening to the patien ts as well as talking to t hem. The model also denotes placing more weight on the patient, urging them to take responsibility in the monitoring of their medications and recording them, including double checki ng prescriptions given. The role of the research intern takes a similar vie w of this model by providing a tool for the participants to use so that they have an easily accessible way to consult with the healthcare providers and give them more accountability in understanding more about their medications. The intern also contributes to opening the lines of communication between the patient and provider if a concern had not already been attended to.

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8 THE IMPACT OF DAILY MEDICATION LISTS GIVEN TO HOSPITALIZED PATIENTS Preliminary Results The final component of the role as the student research intern is the analysis of the collected data. Though data collection is not yet complete interim data was analyzed and preliminary results presented findings fluid with the results of the pilot study, as well as with the purpose questions we hoped to answer through the project. Results were taken from the daily p atient survey to look at stat istics of the intervention unit responses as well as the concerns identified The findings from the control and intervention units were then organized on Ex cel into bar graphs to compare the results of the final day quest ionna ire. The first component analyze d by the research intern was whether or not the daily medication list was useful as a tool for the participant to present any concerns. A study by Hobgood, Peck, Gilbert, and Chappell (2012) found 88% of patients wish to ha ve full disclosure of any medical error. This is imperative because if patients wish to know about errors after they have occurred, then they likely would be more willing to take part in preventing them from taking place. When looking at data collected fro m the daily patient surveys conducted on day 1, or the day that the participants were enrolled into the study, out of the 43 patients who had received a list that day 27.3% answered yes to question 4 on the survey about whether they identified any errors (see Table 1). Table 1 Daily Patient Survey: Admission day/day 1

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9 THE IMPACT OF DAILY MEDICATION LISTS GIVEN TO HOSPITALIZED PATIENTS Admission Day Did you receive a daily medication list today ? After reviewing the list, did you have any questions or concerns about your medications? Did your nurse, pharmacist or physi cian address your medication questions to your satisfaction? Did you identify any medication problems today? Yes 43 (78.2%) 14 (32.6%) 35 (63.6%) 15 (27.3%) No 12 (21.8% ) 29 (67.4%) 5 (9.1%) 40 (72.7%) NA 0 0 15 (27.3%) 0 Note. NA = not applicable After having the patient expand on their specific concerns some of the common issues were incorrect dose of a medication, allergy to a medication prescribed, incorrect patient, and a discontinuation of home medications. These findings are significant not only because they are concerning to the safety of the patient, but they are also consistent when reviewing the literature. Accordi ore than 40 percent of medication errors are believed to result from inade quate reconciliation in handoffs during admission, transfer, and discharge of reconciliation, a way to review the pati ents medications they were taking prior to admissi on to the hospital and the inpatient medications they are now taking, has a multitude of factors that contribute to a fault in this area such as a lack of communication between patient and provider and insufficient patient knowledge about specific medications (Barnsteiner, 2008). The common trend found in the study was that many of the concerns patients presented w ere due to this faulty communication. Participants were not being explained why they were t aken off the ir home

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10 THE IMPACT OF DAILY MEDICATION LISTS GIVEN TO HOSPITALIZED PATIENTS medications or that they may actually have been put on a different brand of the medication taken at home simply because the hospital did not carry their brand. Another component analyzed was th e final day satisfaction survey to see the impact th e list had on prompting participants to speak up about their concerns Though preliminary results included a sample of 55 patients on the intervention unit, only 17 of these patients received the final day survey due to an early disc harge. Of these 17 part icipants 82% strongly agreed t o statement and every participant agreed in some degree to statement F list caused me to be more inv oth statements clarify the list was useful in increasing engagement of the participants in their hospital care. Table 2 was useful made me more aware improved medication safety encouraged by doctor, nurse, pharmacist to ask questions made it easier for me to ask question m ade me more involved in my medical care Strongly disagree 0 0 0 0 0 0 Mod disagree 0 0 0 0 0 0 S light ly disagree 0 0 1 (5.9%) 1 (5.9%) 1 (5.9%) 0 Slightly agree 0 0 1 (5.9%) 1 (5.9%) 0 2 (11.8%) M od agree 3 (17.6%) 2 (11.8%) 1 (5.9%) 8 (47.1%) 2 (11.8%) 2 (11.8%) Strongly agree 14 (82.4%) 15 (88.2%) 14 (82.4%) 7 (41.2%) 14 (82.4%) 13 (76.5%) Note. Mod = moderately

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11 THE IMPACT OF DAILY MEDICATION LISTS GIVEN TO HOSPITALIZED PATIENTS Statistics also show that 70.6% of the experimental group asked questions regarding their medications, compared to 50.9% of the participants who asked questions in the control group (see Figure 1) Figure 1. confidence in each of the statements on the survey. Control unit and intervention unit confidence are compared for each item. 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Control Unit Intervention Unit Control Unit Intervention Unit Ask MD why being prescribed a new med Ask RN to explain the purpose of a med str agree mod agree slight agree slight disagree mod disagree str disagree

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12 THE IMPACT OF DAILY MEDICATION LISTS GIVEN TO HOSPITALIZED PATIENTS Figure 1 (continued) These statistics are c onsistent with the literature which also found that interventions with verbal (Davis, A nderson, Vincent, Miles, & Sevdalis, 2011). Aspden et al (2006) reported similar views: C onsumers need to be empowered to play an active role in their care through the establishment of patient rights that are ensured at all points along the medication use continuum, enhancing the presence, power, and participation of consumers in their relationships with providers 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Control Unit Intervention Unit Control Unit Intervention Unit Control Unit Intervention Unit Does not look like the right med Have an allergy to a med Med is late str agree mod agree slight agree slight disagree mod disagree str disagree

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13 THE IMPACT OF DAILY MEDICATION LISTS GIVEN TO HOSPITALIZED PATIENTS Comparing the intervention and control degree of confidence of addressing specific items listed on page 3 of the final day survey expan ds on the impact of the daily medication list. For each of the statements listed on the questionnaire the control unit had a portion of participants wh o disagreed to these statements whereas the participants on the intervent ion unit w ere all in agreement t o some degree (see Figure 1) The control unit also had disagreement over the statements about presenting concerns of having an allergy to a medication prescribed or telling a nurse that the medication does not look like the medication that is su pposed to be taken (see Figure 1 ). The disagreement is paramount to the study because it exemplifies that the participants who had the list at hand felt more confident confronting a clinician than those who did not have a list of their medications. Ultimately, not only do we want patients to have confidence to speak up about concerns to decrease the prevalence of errors, but we also want the patients to be satisfied with the receiving the list. Thus, results indicate 82.4% found the list to be useful and would like to receive a list of their medications during future hospital visits (see Table 2) Patient satisfaction is a key component i n gauging the effectiveness of the daily medication list because for the patients to be involved and actually use the list, they mu st find it helpful. Problems and Limitations The study has several limitations due to its design. First, because the study uses convenience sampling in place of random assignment the population represents the population of the control and intervention uni ts, but may not be a good representation of the population in its entirety. This could pose a problem with the future goal of having this intervention implemented on other units at Shands because of the diversity in specific unit populations. Second, becau se the instrument is a survey most patients preferred that the survey be read aloud to them instead of them reading it themselves. This created a problem when conducting pages 2 and 3 of the final

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14 THE IMPACT OF DAILY MEDICATION LISTS GIVEN TO HOSPITALIZED PATIENTS day survey which are likert scales The research intern had to explain to the patient that their answers could ran ge trongly disagr However, for those who completed the survey by having the researc h intern read aloud the options many chose only either 1 o r 6 as their answers. As a result, this could skew the data for the answers on this su rvey. The student intern began to urge the participants from that point on to read the survey themselves; however, future use of this method should require that the patie nts complete the questionnaire by reading it on their own. Also, i f the study was expanded possibly making changes to the likert scale could be more beneficial. For instance, providing an instrument where the ends of the likert scale are bipolar for each q uestion so that the participant does not continually mark the same answer and will then have to read through each response. Educat ion level of the participants is an aspect that is not a part of the inclusion criteria fo r the study participants and conse quently has impacted the study. The level of education of a participant significantly impact s their willingness to want to participate because those who are less educated may not see the importance of the intervention. A large part of finding the medication list useful is whether or not the participant understands the concept of patient centered care. According to Aspden et al (2006), improvement in safety and quality of medication administration requires all patients to have a thorough understanding of client centered care including what it entails as far as their role, as well as what to expect from a provider as a patient. Therefore, e ducation le vel of a high school diploma, the research intern suggests would be an im portant component to include as part of the criteria of the target population. Lastly, staff compliance has hindered the study process. The nurses on the intervention unit were informed of the study months before the start date. For that reason, the firs t few weeks

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15 THE IMPACT OF DAILY MEDICATION LISTS GIVEN TO HOSPITALIZED PATIENTS the study was implemented the nurses were forgetting to hand out the daily medication lists to their patients. It is vital in the study that the participants on the intervention unit receive the list con secutively and so as the research intern much time was spent constantly educating the nurses about the study in order to gain compliance. A method propose d that could help this problem would be to insert an area into the Epic computer documenting system used by the nurses at Shands and could be t accessible reminder to ensure the list is being given as needed. Conclusion As a no vice researcher the participation in the s tudy strengthened the knowledge of the research process as a whole and was a great learning experience. Like any research study though execution we were able to find the weak areas and have noted this for future ch anges. Although further work is required to complete the study in its entirety, results thus far have been on target for what we hoped implementing a daily medication list would do. The statistics illustrate that the list has helped make communication between the patient and provider more efficient, make healthcare team while in the hospital, and thus more satisfied with their management of their medications A large feature in the detecting and reporting of potential errors was increased and this helps to improve safety in the process of medication administration. Most importantly, the participants were excited to be given the chance to be involved and this made them want to stay educated both about the medications they were receiving and about their healthcare pro cess. By being given the role as the research intern light was shed on the importance the medication list has on the delivery of safe patient care and its necessity to be utilized on all units in the hospital.

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16 THE IMPACT OF DAILY MEDICATION LISTS GIVEN TO HOSPITALIZED PATIENTS References Aspden, P., Wolcott, J., Bootman, L., Cronenwett, L. R. (2006). Preventing medication errors: Quality chasm series. Washington, DC: The National Academies Press. Barnsteiner, J. H. (2008). Patient safety and quality: An evidence based handbook for nurses Rockville, MD: Agency for Healthcare Research and Quality. Available from http://www.ncbi.nlm.nih.gov/books/NBK2648/ Burroughs, T.E., Watermann, A.D., Gallagher, T.H., Jeffele D.B., Dunagan, W.C., Fraseraser, Joint C ommission Journal On Quality and Patient S afety 33(1), 5 14 Davis, R. R., Anderson, O. O., Vincent, C. C., Miles, K. K., & Sevdalis, N. N. (2012). Predictors International Journal of Nursing Studies 49 (4), 407 415. doi:http://dx.doi.org.lp.hscl.ufl.edu/10.1016/j.ijnurstu.2011.10.013 Doherty, C., & Sta vropoulou, C. (2012). Patients' willingness and ability to participate actively in the reduction of clinical errors: A systematic literature review. Social Science & Medicine 75 (2), 257 263. doi:http://dx.doi.org.lp.hscl.ufl.edu/10.1016/j.socscimed.2012.0 2.056 Hobgood, C., Peck, C., Gilbert, B., Chappell, K., & Zou, B. (2002). Medical errors -what and when: What do patients want to know? Academic Emergency Medicine 9 (11), 1156 1161. Institute of Medicine. (2006). Preventing medication errors Retrieved from http://www.iom.edu/~/media/Files/Report%20Files/2006/Preventing Medication Errors Quality Chasm Series/medicationerrorsnew.pdf

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17 THE IMPACT OF DAILY MEDICATION LISTS GIVEN TO HOSPITALIZED PATIENTS The Joint Commission. (2012 ). Facts About Speak Up I nitiatives Retrieved from http://www.jointcommission.org/as sets/1/18/Facts_Speak_Up.pdf

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18 THE IMPACT OF DAILY MEDICATION LISTS GIVEN TO HOSPITALIZED PATIENTS Appendix A

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19 THE IMPACT OF DAILY MEDICATION LISTS GIVEN TO HOSPITALIZED PATIENTS Appendix B

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20 THE IMPACT OF DAILY MEDICATION LISTS GIVEN TO HOSPITALIZED PATIENTS Appendix C

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21 THE IMPACT OF DAILY MEDICATION LISTS GIVEN TO HOSPITALIZED PATIENTS Appendix D