Date of Graduation

Fall 12-16-2023

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)


School of Nursing and Health Professions


Kaiser cohort MSN capstone

First Advisor

David Ainsworth



This quality improvement project aimed to use a weekly medication planner to enhance medication adherence in a home health setting to help improve patient healthcare outcomes. A weekly medication planner helps patients manage their medications. Systematic reviews and meta-analyses show medication planners increase adherence. Morisky 4-item survey assessed patient opinions pre and post intervention.

Problem:. Medication adherence is an important part of home health patient care that affects health outcomes and safety. The problem is patients received an abundance of discharge medications and do not have enough time with a Registered Nurse discharge planner to go over their medication side effects and to help plan a weekly planner to put into place. Using the Morisky 4-item questionnaire, the baseline data total score of 21 was collected for 20 patients with chronic conditions of Congestive Heart Failure (CHF), Diabetes Mellitus(DM), and/or Hypertension (HTN), without a medication planner. The team aim to decrease the rate of drug non-adherence to a total score of 7 total points.

Context: The setting for this project is a large, hospital-based home health agency, with an average daily of 361 patients, composed of Alameda County patients and Contra Costa County patients with chronic and acute conditions, with diagnoses of CHF, DM, and/or HTN with problems of polypharmacy.

Interventions: Qualitative pre- and post-surveys were conducted to gather patient perceptions on the medication planner and its impact on medication adherence. The 4-item Morisky adherence survey questionnaire was used to evaluate patient medication adherence after using the medication planner.

Measures: The outcome measure was to decrease the rate of drug non-adherence total score from 21 total points at baseline to an updated score of 7 total points by July 18, 2023, using the 4-item Morisky questionnaire survey in home health CHF, HTN, and/or DM patients upon third component of addition use of a weekly medications planner.

Results: For each patient totaling of greater than 2 total points after answering the Morisky 4-item questionnaire signified medication adherence rate was low. Of the 20 patients, a maximum of 40 points signified very low adherence. The maximum low adherence score was 16 total points for 8 patients. After three weeks, 8 patients were further chosen as a subgroup, using a simplified revised planner. These patients had a pre-survey score of 11 points, which further decreased to 7, a 4-point improvement. Patient outcomes and satisfaction were both evident, as patients did not readmit and had better health outcomes, using the revised planner.

Conclusions: A weekly medication planner is necessary to improve compliance in a home health setting. Medication adherence affects health and safety. Clinicians who provide great cooperation and communication with their patient’s weekly medication planner also affect patient satisfaction and motivation.