Patient Accountability

Posted: Tue, Feb 10, 2015 14:32

Do you know the second and third questions of the HCAHPS Transition of Care domain?

When I left the hospital, I had a good understanding of the things I was responsible for in managing my health.

When I left the hospital, I clearly understood the purpose of taking each of my medications.

Consider This:

The key to earning an “Always” on the second HCAHPS Transition of Care question is Patient Accountability - our ability to teach patient and family to be active, responsible participants in the healing process.

I read something recently that said 40% of crucial decisions (not life decisions or ICU) are made with the help of a surrogate; they are involved on the patient’s behalf to help make decisions with doctors and with nurses. This is a trend that is increasing, so we need to be able to teach our family members what’s needed for a safe transition.

Let patients and family know that when they leave the hospital they become (by default) their own Care Coordinator. Encourage patients to assert that role by telling health professionals what they need. Empower them to be assertive! Teach them about diet, exercise, medication regimens, etc. so that the patient and their family are prepared for a safe transition. 

You’ll know patients are self-reliant and ready for discharge when they participate actively in their care plan, when they know their diagnosis and prognosis, when they speak confidently about meds and side effects. When they’re working with determination at physical or occupational therapy, when they’ve set goals for rehab or recovery. When they’re supported by knowledgeable family caregivers. You’re going to know when they’re ready; trust your instincts.

On the other hand, do you have reason to believe your patient will need extra care after being discharged? Your intuition is going to tell you that, too. You’ll see them less alert, less aware, or less involved in their care as you think they should be. Your responsibility is to alert the following people to the fact this patient is potentially “at risk” and will need supervision.

• the attending physician
• the case manager/social worker
• the next care facility (if they are transitioning to SNF, for example)
• and the patient’s family or other home caregivers

How will you encourage your staff to develop a Cycle of Service and Reward Strategy for patient accountability?

HCAHPS #3 – Medication Self-Mastery

The key to earning an “Always” on the third HCAHPS Transition of Care question is Medication Self Mastery - assuring a safe transition home by skillfully teaching patients about their meds, when to take them, and what to do if potential adverse effects occur. Consider revisiting the previously posted about Medication Education - lots of handy tips and tricks there – or using the MMAS (Morisky Medication Adherence Scale). The MMAS has some very practical questions that you ask the patient:

• Do you ever forget to take your medicine?
• Are you careless at times about taking your medicine?
• When you’re feeling better, do you sometimes stop taking your medicine before you should?
• Sometimes, if you feel worse when you take your medicine, do you stop taking it, because you don’t think it’s good for you?
• Do you know the long-term benefit of taking your medicine as explained by your doctor or pharmacist?
• Sometimes do you forget to refill your prescription on time?

These are very thoughtful set of questions that you can use. Above all, you want to ensure patients know their medications by using Teach Back. To confirm they’ve got it, ask the patient to teach-back, or restate, how they’ll perform their medication regime, the reason why s/he is taking each medication, the positive effects of taking the medication(s), symptoms/side effects and what to do if they occur. What about refill dates? How long will s/he remain on the medication(s)?

Develop a Care Transition Team to educate all clinical staff. A Care Transition Team should allow members to share their unique skills by visiting Service Huddles or monthly Staff Meetings, or by working with a Process Improvement Team that’s become stuck while solving a transition problem. The Care Transition Team phone call or home visit needs to take place within 36 hours of discharge for all at-risk patients - that’s not an option. The call is either to the patient, or to the RN in the transition facility (if patient has not gone home). Check on the patient’s status regarding medications, and answer questions regarding medication regime or possible reactions to the meds.

The Take Away:

Education for life after a hospital stay should not begin two hours before discharge.

Empower your care transition team to devise strategies that involve the patient in accepting personal responsibility for his health and well-being after his hospital stay.

It’s crucial to follow-up on medication compliance. 

Medication errors and the 5^th leading cause of death in the United States, according to http://mypicturerx.com/ - we cannot afford to relax about this!

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