Helping patients safely and independently take their oral medications is one of the many critical roles played by home health nurses, particularly given that trouble taking medications is a top reason patients might land back in the hospital.
At NYU Langone’s Certified Home Health Agency (NYU CHHA), a new initiative has significantly boosted the number of patients who agency staff have helped toward this important goal. Implemented by a fellow with United Hospital Fund and Greater New York Hospital Association’s Clinical Quality Fellowship Program, the effort saw the percentage of patients who improved their ability to take their medications correctly during home care rise from 70 to 79 percent.
That increase will make a big difference in the lives of hundreds of patients in NYU Langone’s care, according to fellow Jenna Blind, DNP, RN, CPHQ.
“Being able to manage oral medications is really important to prevent emergency department visits, prevent readmissions, improve disease process, decrease exacerbation of illness, and to give patients autonomy and increase their satisfaction,” said Dr. Blind, who is NYU Langone’s home care and home hospital director of education, professional development, and quality improvement.
But perhaps even more significant than the boost to the medication management metric is the CQFP project’s impact on the home health agency’s quality improvement process.
Dr. Blind notes that an interdisciplinary work group approach used for the project was so successful that staff have decided to use it for improving eight other metrics that contribute to what’s known as the agency’s Quality of Patient Care (QoPC) Star Rating. The new interdisciplinary teams have already seen success in tackling important patient outcomes, Dr. Blind said, including reducing hospitalizations, increasing mobility, and improving patients’ self-care skills.
As opposed to each department and discipline tackling initiatives on their own as they might have previously, the new work groups engage frontline staff, leadership, rehab specialists, pharmacists, and other relevant disciplines in each project workgroup.
“It's really a new way that we look at quality improvement in the agency,” Dr. Blind said. “My favorite part of the [CQFP] project was developing a new way to get people excited about quality improvement—we were able to change the culture.”
Along with the new projects, Dr. Blind is still tracking the success of her original CQFP project. In that project, the medication management metric increased by 7 percent within 12 months, surpassing the work group’s own goal of a 5 percent increase. It has since risen further to the 79 percent average.
To drive this change, Dr. Blind focused on three prongs: educating clinicians on properly documenting patient's ability to manage their medication, setting up tools to help patients improve (including pill boxes, automatic dispensers, etc.), and collaborating with pharmacy experts to help manage particularly complex medication regimens.
Each of the interventions helped to not only accurately monitor how patients were managing their medications but increase the number of patients who improved these skills during their time under home care. Improvement is based on how far patients move on a four-point scale of three to zero from the beginning of their episode in the NYU CHHA to their discharge, with “three” signifying those who can only take medication correctly when it is administered by another person and “zero” signifying those who can take oral medications correctly on their own.
Dr. Blind notes that both the success of the medication management project and the boost it offered to further quality improvement efforts at NYU Langone Certified Home Health Agency are a credit to confidence she gained during the Clinical Quality Fellowship Program.
“CQFP refined my skills and has empowered me to be a mentor for other people,” Dr. Blind said. “If I can help people not be afraid of quality improvement, I love to do that—[CQFP] gave me the courage to move into the mentorship space instead of the mentee space.”
Started in 2009, the Clinical Quality Fellowship Program has trained more than 300 mid-career physicians, nurses, and physician assistants from over 50 health care facilities in the New York metropolitan area to become quality improvement and patient safety leaders in their organizations. The 15-month program graduates a new class of these change-makers on the front lines of health care each year.