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Innovation Attempt

Education and Reminder Card for Those on Multiple Medications Enhances Patient Understanding, But Not Satisfaction or Safety


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Summary

Concerned about the large number of patients discharged on multiple medications and the associated risk of drug interactions and adverse drug events, the Mayo Clinic Department of Medicine developed a computer-generated, customized patient medication education and reminder card for these patients. Because many patients have low health literacy and are elderly, the medication information on the card is written at a 6th-grade level and in a large font. Nurses use the patient's medication list, a customized medication database, and programmed features to generate the medication instructions on a durable card. An evaluation comparing the new medication card to the current medication discharge worksheet found no significant difference in measures of patient satisfaction and patient safety (i.e., self-reported medication errors). Patients using the card did report higher levels of understanding of their prescribed medications than did those using the worksheet.
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Developing Organizations

Mayo Clinic
Rochester, MNend do

Date First Implemented

2001

Problem Addressed

Hospitalized patients, especially the elderly with comorbid conditions, are often discharged with multiple medications, which increases their risk of drug–drug interactions and adverse drug events. Medication education—an essential component of the discharge process—can help to prevent adverse events, but many hospitals fail to provide adequate instructions to patients.1
  • Multiple medications: Adults with comorbid conditions are discharged from hospitals with an average of six medications. Elderly adults with heart failure are discharged with an average of eight medications.2
  • Leading to risk of adverse drug events, especially in frail elderly: The overall rate of adverse drug events in this population was estimated to be 50.1 per 1,000 person-years.3
  • Adverse drug events are preventable, but education is often lacking: Predischarge education can help to prevent adverse events and readmissions, but such education is often uncoordinated and unstructured, leading to nonadherence and rehospitalizations in vulnerable populations.1

What They Did

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Description of the Innovative Activity

The Mayo Department of Medicine Quality Improvement Medication Reconciliation Team developed a medication education and reminder card for patients discharged from the hospital on multiple medications. Nurses use the patient's medication list and a customized medication database and features to develop each patient's instructions, which are printed on a durable card. Known as "Durable Display at Discharge," the card has the following features:
  • Target audience: The card is designed to assist elderly patients and those with low health literacy who are discharged on multiple medications. During a trial of the program, the card was used on all adult patients (ranging in age from 20 to 100 years) discharged on three or more medications.
  • Lay language: The text is written at a 6th-grade reading level.
  • Large text: The text uses a large font (11 or 12 point) rather than the traditional 10-point font.
  • Easy-to-understand explanations of medications and side effects: The card provides the medication trade name, large headings that explain each drug's purpose (e.g., to control blood pressure), and corresponding comments and cautions about the medication (e.g., be aware that this medicine slows the heart rate, watch out for dizziness).
  • Reminders to boost compliance: The "time-to-take medications" section of the card has a large heading and lists five separate time periods (morning, noon, afternoon, evening, and bedtime), with space under each time period to list the number of pills to take for each prescribed drug.
  • Medication display: To ensure that patients understand which medication to take, the card has a "display" heading for each drug with space for the nurse to affix a pill or tablet.
  • Discontinued medications: The card includes a heading about medications that should be discontinued, with space to list medications the patient should no longer take (including over-the-counter medications).

Did It Work?

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Results

An evaluation comparing the new medication education card to the established medication discharge worksheet found no significant difference in measures of patient satisfaction and patient safety (e.g., self-reported medication errors). Patients using the card did report higher levels of understanding of their prescribed medications than did those using the worksheet.
  • No difference in reported satisfaction: A postdischarge phone survey of 138 patients (discharged on an average of 9.4 medications) found similar levels of satisfaction between those receiving the card and those receiving the medication discharge worksheet. The mean scores were 4.24 (card) and 4.26 (worksheet).
  • No difference in self-reported medication errors: The survey showed no difference in self-reported medication errors among the two groups. The mean scores were .78 (card) and .76 (worksheet).
  • Higher understanding of medications: The survey suggests that those receiving the card had a better understanding of their medications than did those receiving the worksheet. The mean scores were 1.96 (card) and 1.66 (worksheet).
  • Limitations: Only 138 patients of 337 study participants completed the postdischarge survey. The high attrition rate was related to the survey being conducted within 14 days after hospital discharge. Another limitation was that most discharge nurses didn't complete the medication reminder card by attaching the patient's pill/tablet to the display column on the card.

What They Learned

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The developers of the program believe that the following could have helped to increase the effectiveness of the Durable Discharge Display:
  • Focus on those at highest risk: During the trial, the card was given to patients over the age of 20 years who were discharged on three or more medications. A better approach might be to use the card only for the elderly and for other patients who appear to have difficulty understanding their medication regimen. It might also make sense to use the card only for those discharged with a higher number of medications (e.g., eight or more).
  • Make the card easier to use: Discharge nurses spent much more time generating the education and reminder card (20 minutes) than they did the medication discharge worksheet (3 minutes), making the card impractical to use for busy nurses.

More Information

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Contact the Innovator

Dennis M. Manning, MD, FACP, FACC, FHM
Research Chair, Hospital Internal Medicine
Mayo Clinic
200 First St., SW
Rochester, MN 55905
(507) 255-8716 (secretary)
E-mail: manning.dennis@mayo.edu

Innovator Disclosures

Dr. Manning has not indicated whether he has financial interests or business/professional affiliations relevant to the work described in this profile.

References/Related Articles

Manning DM, O'Meara JG, Williams AR, et al. 3D: a tool for medication discharge education. Qual Saf Health Care. 2007;16:71-6. [PubMed]

Footnotes

1 Martens KH. An ethnographic study of the process of medication discharge education (MDE). J Adv Nurs. 1998 Feb;27(2):341-8. [PubMed]
2 Forster AJ, Murff HJ, Peterson JF, et al. The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med. 2003;138(3):161-7. [PubMed]
3 Gurwitz JH, Field TS, Harrold LR, et al. Incidence and preventability of adverse drug events among older persons in the ambulatory setting. JAMA. 2003;289:1107-16. [PubMed]
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Original publication: January 19, 2009.
Original publication indicates the date the profile was first posted to the Innovations Exchange.

Last updated: January 15, 2014.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.

Date verified by innovator: November 22, 2011.
Date verified by innovator indicates the most recent date the innovator provided feedback during the annual review process. The innovator is invited to review, update, and verify the profile annually.

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