Date of Graduation

Fall 12-11-2020

Document Type

Project/Capstone

Degree Name

Master of Science in Nursing (MSN)

College/School

School of Nursing and Health Professions

First Advisor

Dr. Nancy Taquino

Second Advisor

Dr. Cathy Coleman

Third Advisor

Dr. Jonalyn Wallace

Abstract

Problem The Home Healthcare Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) survey question 14 regarding providers discussing possible side effects is below the organizational goal of 74.1 linear mean in this home health microsystem.

Context According to the Agency for Healthcare Research and Quality (AHRQ), nearly 20% of patients discharged home from the hospital had an adverse event within the first few weeks of discharge and most are related to medications (AHRQ, 2019).

Interventions An innovative contest was introduced to promote engagement and to use teach-back best practices, including planned discussions with the patient and caregivers regarding name of medication, purpose, and potential side effects.

Measures Four measures were incorporated for evaluation: Percentage of field staff introduced to HHCAHPS question 14 with rationale; Percentage of the monthly supervisor tracer visits identifying use of the medication side effect education (MSE) tool; Percentage of patients and caregivers recalling if side effects were discussed in a previous visit; Number of contest entries and clinician participation to monitor staff engagement.

Results One hundred percent of the staff were educated on the rationale and importance of HHCAHPS question 14 in the first month of implementation. Usage of MSE tool improved from 31% in May to 100% by September. Patient recollection of side effect discussed improved from 31% to 100% in September. Contest entries increased by 57% from 103 (June) to 182 (September). Individual clinician participation increased from 18% to 55%. Over four months question 14’s monthly score varied from 79.2 in April to 73.5 in July 2020, raising the performance year-to-date linear mean from 69.2 in April to 70.4 (July).

Conclusions In the home health setting, the introduction of an innovative contest to stimulate interdisciplinary team participation led to overall improvement in both patient and organizational outcomes. The Clinical Nurse Leader facilitated a culture of learning, safety, and improvement to optimize HHCAHPS outcomes. Furthermore, despite the occurrence of an ongoing pandemic, the staff teams remained enthusiastic and engaged with support of all levels of home health management and leadership.

Keywords: medication side effects, teach-back, innovative contest, HHCAHPS outcomes, team engagement, clinical nurse leader

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