Essay Paper

January 2020

The topic that my group was assigned was Improving Hospital Discharge through Medication Reconciliation and Education. With nurses caring for such a wide variety of populations, there are bound to be some sort of medical barriers to arise. This could be in the form of language or cultural barriers, social isolation, and even attitudes of health care personnel towards patients of low socioeconomic status. Whatever it may be, there needs to be improvement upon being discharged to improve the overall quality of care to the patient, lower readmissions rates and to help lower cost of care.

Clinical Question

The transition from a health facility to home is an intricate and susceptible period for most patients. This is due to the ineffective hospital discharge that most patients go through. Poor organization and inefficient discharge planning lead to increased cases of readmissions, increased cost of care, patient injuries, adverse effects (AEs) and patient dissatisfaction. Also, poor medical reconciliation is the main cause of medication errors and can follow a patient during her hospital stay.

Studies have revealed that around 20% of all medical patients are faced with an adverse effect within 35 days of hospital discharge. The least common AEs are incorrect medication prescription and the most common AEs are adverse drug events which constitute over 60 %. Poor communication between the patient and the health practitioner is the major cause of many AEs (Sherman, 2016). Of the three heart failure patients, one is likely to be readmitted within 30 days after being recharged from a hospital. In 2011, a study showed that 32 percent of 564 discharged patients had laboratory tests that were not conducted. Of the 32 percent, only 11 percent of the patients had documentation of their pending tests. Readmissions that happen within 1 month of discharge cost the United States healthcare system an average of $ 15 billion each year (Hennen & Jorgenson, 2014).

The PICOT question

Do effective medication reconciliation and education to patients about the need to take their medicines on time and as scheduled, compared to ordinary practice (ineffective medication reconciliation and no education to patients on the importance of sticking to the schedule when taking medication), lead to an improved hospital discharge process and reduced cases of readmissions, satisfied patients within 1 month for adult patients?

Population (P): Discharged adult patients

Intervention (I): Effective medication reconciliation and education to patients about the need to take their medicines on time and as scheduled.

Comparison (C): ordinary practice- medication reconciliation and no education to patients on the importance of sticking to the schedule when taking medication.

Outcomes (O): Patient satisfaction, reduced cases of readmissions, improved process of hospital discharge.

Time (T): Within 1 month after discharge.

Purpose of your paper

The purpose of this paper is to show how medication reconciliation, effective discharge planning and education to patients about the need to take their medicines on time and as scheduled is crucial in improving the process of hospital discharge for patients, reducing cases of patient readmitting, reducing injuries to patients and cases of AEs and also how this can save the overall cost of treating the readmitted patients.

Levels of Evidence

The type of question asked is a Prognosis question. This is because it determines a course over a given time (medication reconciliation, effective discharge planning and education to patients) and a guess to the expected outcomes (reduced cases of patient readmitting, reducing injuries to patients, and an improved process of discharging patients)

The above question can be answered better by a Cohort and Case-control studies because it involves following up a group of discharged patients after medication reconciliation and an effective discharge planning and education to them, and note down the outcomes comparing them with the expected results.

Search strategy

The databases used are the Chamberlain library, Medline, PubMed, and Google Scholar. This was achieved by turning the PICOT framework into a clinical research topic. An example of a clinical research topic is “Medication reconciliation and Education as a method of improving hospital discharge”. The search terms from such a topic include: Medication Reconciliation, Educating patients, and improving hospital discharge. Also, I combined Population (P) and Intervention (I) to get another search topic: adult patients and effective medication reconciliation.

Using my search terms and topics resulted in so many articles and in order to save time and get the best and appropriate articles, I did put limits on my search. The databases I used gave me an option to put limits on my searches and the ones are used include type of article (reviews), age (adults) and Language (English). The two chosen articles include: “An initiative to Improve Patient Education by Clinical Nurses” by Jessica R. Sherman "Improving handoff communication from hospital to home: the development, implementation, and evaluation of a personalized patient discharge letter" Bianca M. Buurman, Kim J. Verhaegh, Marian Smeulers, Hester Vermeulen, Susanne E. Geerlings, Susanne Smorenburg, and Sophia E. de Rooij

These two articles were selected because they have quality and relevant answers to the questions at hand. The articles had a manageable number of pages to read and hence no time can be wasted when looking for the evidence and answers. The two articles are also broad enough in that the information they provide can also be used later in my studies and also for my personal experience.

Conclusion

A considerable effort was made to refine the search terms so as to come up with the best articles to be used in the next assignment. The above two articles contain the required quality to answer the questions and also equip the reader with relevant information that can be used in the field.

References

Buurman, B. M., Verhaegh, K. J., Smeulers, M., Vermeulen, H., Geerlings, S. E., Smorenburg, S., & Rooij, S. E. D. (2016). Improving handoff communication from hospital to home: the development, implementation and evaluation of a personalized patient discharge letter. International Journal for Quality in Health Care, 28(3), 384–390. doi: 10.1093/intqhc/mzw046

Hennen C.R and Jorgenson A. (2014) “Importance of Medication Reconciliation in the Continuum of Care” 14: pg. 1-3

Sherman, J. R. (2016). An initiative to improve patient education by clinical nurses. Medsurg Nursing, 25(5), 297.