The Golden Ticket: Improving Medication Side Effects Teaching on a Telemetry Floor

Purpose:
In Q1 of 2014, Our HCAHPS Communication About Medicine Domain score was at the 8th percentile against Press Ganey's All Hospital DB. Since we pride ourselves in taking best care of our patients, we were determined to change this score. Our goal was to reach the 75th percentile within one year.

Relevance/Significance:
In the healthcare Pay for Performance reality is what we all are faced with. One of the performance measures that are looked at are satisfaction scores and particularly satisfaction scores concerning medication teaching and communication. In addition to do effective medication communication and teaching is simply the right things to do! There is evidence that clear medication understanding can prevent complications, comorbidities and readmission.

Strategy and Implementation:
The key tactics that brought us success: 1. HCAHPS scores and comments were pulled out every Monday morning, and reporting to Nurse Leaders and staff, through email and huddles. 2. Monthly mandatory staff meeting where we share our score, struggles and successes openly; 3. Golden Ticket process—golden-colored ‘ticket' form that is begun by nurse on pm shift. This nurse reviews new medication with a patient, including possible side effects. This nurse writes the name of the medication on the Golden Ticket and signs and dates the ticket,indicating he/she has completed the medication review with the patient.The Golden Ticket is then left in the patient room for the am shift nurse.The am nurse will review the same medication again with the patient, again reviewing possible side effects as well. The am nurse then signs and dates the ticket and leaves in the patient room. The Nurse Leader, upon her round, validate the process with the patient and do real time coaching if needed.

Evaluation:
We were able to over time increased CHAPS Domain score in Communication About Medicines from 8th%tile the first quarter of 2014 to the 95th%tile the first quarter of 2015! While working on this goal, we noticed that our Overall score had also increased from the 44th percentile to the 93rd percentile.

Implications for Practice:
Improvement in medication communication is possible by hardwiring clear process, begin transparent about results, being focused on the outcomes, providing real time coaching and celebrating success.