Accreditation Resource Services Newsletter
November 2020

CIHQ-ARS Article

Medication Education Pearls

By: Gina Miller
Teaching patients and/or family members or support person(s) about their medication regimens clearly has benefits not only to the patient but also to the hospital. Education regarding medications will improve adherence to medication regimens, improve patient outcomes, and avert readmissions. All teaching is great, but CMS specifically requires documentation of education in certain scenarios. The regulations at §482.25 and §482.43 guide this discussion.
Education must be provided in a way the patient / support person can understand. Before any education is provided, document assessment of the patient’s learning preferences. Healthcare teams should consider the patient’s educational level, reading level, primary language, and sight/hearing abilities when initiating education. This should be documented in the patient’s record. Making assumptions about the patient’s learning preferences is not appropriate and may have a negative impact on retention of information. Determining how a patient learns best dictates how the healthcare team should approach patient education related to medication therapies. Using these preferences in education not only promotes enhanced learning but also supports retention of information. For medication education to be effective, patients must retain the information for a prolonged time. Make sure that education is initiated early in the hospital stay and reinforced prior to and at discharge.
Teaching methods must be based on recognized methodologies. CMS does not prescribe any specific methodologies, but examples include the teach-back, repeat-back approach and simulation laboratories, demonstration, and use of technologies such as videos and DVDs. The patient’s response to education should also be documented into the record. This includes providing instructions in writing as well as verbally reinforcing the education and training. CMS encourages the use of checklists when possible, to reinforce teaching and adherence to education.
What must you teach? CMS describes several specific medication scenarios that must have education documented.
  1. If a new medication is being administered, educate the patient on the purpose of the medication, the intended response, and any significant concerns or precautions that must be taken. This would include recognition of any side effects from the new medication.
  2. If patients are allowed to self-administer a medication, nurses are expected to assess the patient’s or caregiver’s capability to self-administer. Additionally, any concerns about the patient/caregiver’s ability to safely self- administer must be discussed with the practitioner responsible for the care of the patient. Education and training, how it was addressed, along with any concerns discussed with the practitioner must be documented in the record prior to allowing the patient to self-administer any medication.
  3. Hospitals are encouraged to educate patients and/or their family or caregivers about the potential side effects of opioid medications. This includes notifying nursing staff promptly when there is difficulty breathing or other changes that might be a reaction to medication. On discharge, proper storage and disposal of opioid medication should be addressed.
  4. While education should be provided on all medications, anticoagulant education is specifically addressed by the Joint Commission. This does not apply to routine situations for short-term prophylactic anticoagulation used for preventing venous thromboembolism. Include education on adherence to medication dosing and schedule, potential interactions with other drugs and foods, potential for adverse reactions, and the importance of follow-up appoints and laboratory testing (if applicable).
  5. Document information provided to patients undergoing an outpatient procedure that includes the use of sedation or anesthesia. This should include instruction on having caregiver attendance, resting, not performing dangerous activities or using tools, and refraining from making important decisions for 24 hours after sedation/anesthesia.
  6. Written discharge instructions must include a list of all medications the patient should be taking after discharge with clear indication of changes from the patient’s pre-admission medication.
Each time education is provided, include the teaching method and the patient’s/caregiver’s response to the education.
Not only does CMS require you to educate your patients about medication, there are several requirements around education to staff who administer medications. Staff who administer medications must be trained in safe handling and preparation of medications, knowledge of side effects, interactions, compatibility, and dose limits, as well as equipment used in administration of medication. This would include specific training around admixing/compounding of medications if nursing staff perform this task when medications are not readily available from the pharmacy. Staff must also be provided educational resources and programs to improve pain assessment, management, and safe use of opioids.
If an on-site pharmacy is not available 24 hours a day, 7 days a week, a healthcare professional deemed competent by the pharmacist must review all medications prior to the first dose. Specifically the person(s) assigned the job of obtaining after-hours medication must review the patient’s current medication orders and address whether the medication drug, dose, frequency, and route is appropriate, if there are potential interactions or allergies, or if it duplicates another medication currently in use. This is a big responsibility for a staff member, and they must be trained by the pharmacist and deemed competent to perform this function. Remember, this rule does not apply to medications administered under the direct supervision of a physician or in an emergent situation.
Staff, including contracted personnel as applicable, must be educated on the practical application antibiotic stewardship principles, which includes knowledge of guidelines, policies and procedures. The education should include use of nationally recognized evidence-based guidelines for use of antibiotics in the organization.
The hospital is also responsible to have a process to manage and communicate medication shortages. All health care professionals and staff must be educated on how these shortages will be communicated and protocols that will be used to manage medication shortages.
Education is one of our most powerful weapons to change patient outcomes, improve adherence to treatment regimens, and decrease readmission. A few minutes spent teaching patients and caregivers can make a world of difference in patient compliance. Studies have shown medication-related events account for a large percentage of readmissions, however, medication education is still largely fragmented and inconsistent; more than half of patients with prescriptions fail to take them. So teach...and reinforce...and write it down for the patient...and document your teaching each step of the way!

References

Blevens, S. (2020). Medication education: Preparing the patient for discharge. MedSurg Nursing, 29(3), 213-214.
Center for Improvement in Healthcare Quality. (2020). Accreditation standards for acute care.
Center for Medicare and Medicaid Services. (2020). State operations manual appendix A – Survey protocol, regulations and interpretive guidelines for hospitals.
The Joint Commission. (2020). Comprehensive accreditation manual for hospitals, e-edition.
Network for Excellence in Health Innovation. (2012). Improving medication adherence and reducing readmissions: A NEHI issue brief