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Pulse Home Health Care practices skilled health care procedures firmly rooted in the latest research and best practice policies. We routinely mail bulletins to physicians and other medical referral sources to highlight how we help patients and to explain the scientific basis for different services. On our home health website we share selected physician bulletins about Pulse's Home Health Services. If you have questions about how home health could help you, please contact us today.

Home Visits Detect 62% More
Medication Discrepancies
Medication Discrepancies

A study published in the September issue of the Journal of Nursing Care Quality finds that adding in-home nurse visits to the medication reconciliation program detects 62% more medication discrepancies.1  Medication discrepancies rank as a serious problem for millions of adults post hospital discharge.  One of the complications is that few patients arrive at the hospital equipped with complete information about their home medications - especially patients admitted through the emergency department.2  Foster and colleagues found that 72% of adverse events after hospital discharge were adverse drug events.  Medication reconciliation programs have strong potential to reduce hospital readmissions, improve patient safety, and improve patient health.3-7     
 
Medication Discrepancies HelpLinda Costa, PhD, RN, of Johns Hopkins, and colleagues studied a medication reconciliation program for adults discharged from the hospital with four or more prescriptions.1  All participants had to be discharged to home, chronically ill, cognitively intact, and English speaking.  Their intervention included both pre-discharge and post-discharge work for coordinating medication lists and educating patients and family.  Nurses called families 48 hours after discharge to provide additional medication adherence coaching and identify possible medication discrepancies.  Additionally, nurses made home visits after the telephone follow-ups.  The home visits discovered 62% more medication discrepancies that were undetected by the telephone follow-up.  Overall, despite the additional efforts in the hospital, medication discrepancies were found with 67% of patients post-hospital discharge.  Most discrepancies were patient level, nonintentional non-adherence.  Nursing follow-up was able to correct all medication discrepancies identified, and, through this in-home follow-up program, there were no hospital readmissions related to medication non-adherence. 

Other key findings from Costa’s study include:

  • 100% of patients lost their written discharge instructions.
  • Patients who follow-up with their primary care physicians shortly after hospital discharge achieve greater medication adherence.  Many patients who would benefit from medication reconciliation are not homebound. These patients should be scheduled for PCP follow-up shortly after hospital discharge.
  • Several family members commonly share the care of the chronically ill patients.  Coaching the caregivers responsible for the medication regimen is important in resolving discrepancies.
  • The home offers a relaxing, conducive environment for patient education. 
  • In-home visits identify additional, correctable health hazards (e.g. using gas stoves as heating sources, rodent infestations, poor lighting).

References

    1. Costa L, Poe S. Challenges in posthospital care: nurses as coaches for medication management. J Nurs Care Qual. 2011; 26 (3): 243-251.
    2. Costa L, Nelson T. Applying translation science to improve health outcomes. In: Poe S, White K, eds. Johns Hopkins Nursing Evidence-Based Practice: Dissemination and Translation. Indianapolis, IN: Sigma Theta Tau International; 2010: 222-225.
    3. Foster A, Murff H, Peterson J, et al. The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med. 2003; 138 (3): 161-167.
    4. Jack B, Chetty V, anthony D, et al. A reengineered hospital discharge program to decrease rehospitalization: a randomized drial. Ann Intern Med. 2009; 150 (3): 178-187.
    5. Jelinek M, Vale M, Liew D, et al. The COACH program produces sustained improvements in cardiovascular risk factors and adherence to recommended medications - two years follow-up. heart Lung circ. 2009; 18 (6): 388-392.
    6. Karapinar-Carkit F, Borgsteede S, Zoer J, et al. The effect of the COACH program (Continuity of Appropriate Pharmacotherapy, patient counseling and information transfer in Health care) on readmission rates in a multicultural population of internal medicine patients. BMA Health Serv Res. 2010; 10-39.
    7. Peikes D, Chen A, Schore J, Brown  R. Effects of care coordination on hospitalization, quality of care, and health care expenditures among Medicare beneficiaries: 15 randomized trials. JAMA. 2009; 301 (6): 603-618.

 

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