Pilot Project: Developing a Standardized Evidence-Based Education Process for Nurses to Enhance New Medication Eduction of Hospitalized Patients with Heart Failure

Problem Description: Research has shown that health information is difficult for the average adult to understand while clear communication helps patients feel involved and increases adherence to treatment. The Joint Commission recommends Health Literacy (HL) assessment and the use of the Teach Back Method (TBM). Medication errors that occur between the RN and elderly patient are preventable when the RN communicates effectively about the patient’s medications. A paucity of research exists evaluating TBM for nurse-patient communications. This Quality Improvement (QI) Pilot Project (PP) took place over 3-months, aimed to improve new medication education to elderly patients with Heart Failure (HF). Interventions: Telemetry Unit (TU) RN participants received a 3.5-hour Education Program (EP) and a simulation with a Standardized Participant (SP). The EP introduced HL and measurement tools, TBM, and measured the quality of TBM. RNs were surveyed Pre-/Post EP for changes in knowledge, skills and behaviors for HL and TBM. The Short Assessment of Health Literacy (SAHL) was used to measure HL in elders hospitalized with HF. An Observation Skills Checklist (OSC) evaluated TBM during “new medication” education. A Discharge survey for HF patients and a Summative Feedback Session (SFS) survey was used to evaluate RNs opinions about the PP program. Results: A total of 11 TU RNs completed the EP pre/post surveys, showed the greatest gains in knowledge for the TBM behaviors. The comparisons for 11 TBM behaviors, showed the largest change specifically for the selection of the item “Use of non-shaming open-ended questions.” The HL assessment results showed that 67% of the eligible patients received the SAHL-E within the designated 48 hours of admission and HL proficiency was 80%. Of the 10 remaining RN participants, only 4 used the OSC, scores ranged between 13-17; with 17 the highest score possible. At the PP Feedback Session (PPFS), RNs reported the highest importance for TBM and asking patients to explain key information back in in their own words (M = 4.75). There were 8 discharge surveys, n = 7 (88%) report taking medications, n =8 (100%) reported satisfaction with care, and qualitative data about barriers encountered after discharge. Interpretation: The qualitative data responses during the PPFS by RNs reported the EP beneficial and prepared them for the proper administration of the SAHL-E and for TBM. The SP simulation assisted the RNs to practice proper TBM techniques. The benefits for ongoing use of the OSC for annual nursing training, suggested by the RNs as useful for future Peer Observation (PO) coaching of TBM. Conclusions: The EP provided new insight to RNs about HL and proper TBM steps. The patient HL score provided additional support for use of TBM while the OSC provided for PO monitoring of TBM skills. The discharge survey provided qualitative data to support TBM, adherence to medications, new information about barriers following discharge and noted high patient satisfaction