Increasing HCAHPS Through Better Medication Communication

The impact of medication clarity

The HCAHPS survey measures the patient experience over a wide range of domains, from environmental cleanliness to staff responsiveness.[1] Communication is a theme across many domains — and for a good reason: Without clear communication, patients cannot be engaged members of the care team.

Medication communication in particular holds weight, with a dedicated domain and the potential to influence several others — including communication with nurses and doctors, discharge information, and understanding care after leaving the hospital.

The HCAHPS questions covering medication communication are:[2]

• Question 13. Before giving you any new medicine, how often did hospital staff tell you what the medicine was for?

• Question 14. Before giving you any new medicine, how often did hospital staff describe possible side effects in a way you could understand?

• Question 22. When I left the hospital, I clearly understood the purpose for taking each of my medications.

This focus on medication communication is not surprising, given that medication compliance is one of the highest-impact factors affecting patient safety.[3] Medication errors are a leading cause of death, estimated to cause 44,000 to 98,000 deaths each year in the United States — more than the number caused by motor vehicle accidents. Medication errors cause a fifth of hospital readmissions,[4] and for certain conditions, such as heart failure, they can be the best predictor of whether a patient will be readmitted to the hospital.[5]

Clear communication is critical to help avoid medication errors. Patients must know what they are taking, why they are taking it, and how to take it. But there can be a big gap when it comes to medication communication in the hospital. A recent study in JAMA reported that 27% of patients received no verbal instruction on medication changes at all before hospital discharge and 53% were informed about medication changes but not the reason for them. This could explain why around 50% of patients are not taking their medications as prescribed.[6]

Why is medication communication hard?

Despite the profound impact of medication communication on patient safety and the patient experience, healthcare teams struggle to implement it well. It is difficult for nurses in a short-staffed environment to keep up with patient needs. Teaching can get put on the back burner and crowded into a short session right before discharge.

It may also be difficult to locate and print out information to cover all the medications patients are taking. In one study, hospital nurses identified problems they faced with medication teaching. They cited lack of available quality patient medication handouts, limited time to educate, and uncertainty about how much was expected of them.[7]

Without handouts and education materials, nurses may rely on their professional knowledge to educate patients, but this can be inadequate and vary greatly based on experience. Moreover, the complexity of medication teaching can’t be overstated. Over 20,000 medications are available for prescribing in the US, plus countless over-the-counter medications, herbs, and supplements.[8] Layer on long lists of side effects and potential interactions for each, and it’s no wonder that it’s a challenge to identify and communicate what patients need to know.

How to improve medication communication

To improve medication compliance, and related HCAHPS scores, use the following strategies in medication teaching:

• Provide written materials and tools. It’s impossible for nurses to rely on only professional knowledge to cover the necessary medication information. Easily accessible materials can help them give complete instructions.

• Teach-back to check understanding. Have patients repeat what was taught to check that they understand. Using teach-back can also activate multiple learning styles to improve recall.

• Use multiple touchpoints. Every medication administration is an opportunity to teach. Nurses can review what the medication is, what it is for, and possible side effects to watch for. Having reliable references at hand makes this level of teaching possible.

Despite the wide range of potential medications a doctor can prescribe, the top 20 account for around 25% of all prescriptions in the US, according to prescription claims reports.[9] Because of this, a simple, easy-to-use tool covering these common medications can have a big impact for healthcare teams teaching at the bedside.

Common Medication Names, Uses and Side Effects in the Patient Resource Library available from Patient Guide Solutions helps patients understand what side effects to watch for and how to take these medications safely. Plus, with a reliable reference to access later, patients can look up any information they forget.

Conclusion

With the right tools and strategies, healthcare providers can foster better patient engagement in medication teaching, improve medication compliance, and boost overall HCAHPS scores — a critical move for patient safety and experience.

References:

[1] The CAHPS Adult Hospital Survey. Ahrq.gov. Published 2022. Accessed June 15, 2024. https://www.ahrq.gov/cahps/surveys-guidance/hospital/about/adult_hp_survey.html

[2] HCAHPS Survey. March, 2023. https://www.hcahpsonline.org/globalassets/hcahps/quality-assurance/2023_survey-instruments_english_mail.pdf. Accessed June 15, 2023‌

[3] Taiwo Opeyemi Aremu, Oluwatosin Esther Oluwole, Kehinde Oluwatosin Adeyinka, Schommer JC. Medication Adherence and Compliance: Recipe for Improving Patient Outcomes. Pharmacy. 2022;10(5):106-106. doi:https://doi.org/10.3390/pharmacy10050106

[4] El Morabet N, Uitvlugt EB, van den Bemt BJF, van den Bemt PMLA, Janssen MJA, Karapinar-Çarkit F. Prevalence and preventability of drug-related hospital readmissions: A systematic review. J Am Geriatr Soc. 2018;66(3):602-608. doi:10.1111/jgs.15244

[5] Riegel B, Knafl G. Electronically monitored medication adherence predicts hospitalization in heart failure patients. Patient Prefer Adherence. 2013;8:1. doi:10.2147/ppa.s54520

[6] Jimmy B, Jose J. Patient medication adherence: measures in daily practice. Oman Med J. 2011;26(3):155-159. doi:10.5001/omj.2011.38

[7] Wurz S. INCREASING MEDICATION HCAHPS SCORES USING a STANDARDIZED, SIMPLIFIED PROCESS to EDUCATE PATIENTS on COMMONLY PRESCRIBED NEW MEDICATIONS.; 2021. Accessed June 15, 2024. https://scholarworks.montana.edu/server/api/core/bitstreams/bb478bec-d4eb-4315-9e9d-daff88140ba3/content

[8] FDA at a GLANCE. REGULATED PRODUCTS and FACILITIES.; 2019. https://www.fda.gov/media/131874/download. Accessed June, 16, 2024

[9] Definitive Healthcare. Top 20 outpatient prescription medications. Definitive Healthcare. Published 2022. Accessed June 15, 2024. https://www.definitivehc.com/resources/healthcare-insights/top-outpatient-prescription-medications