Marcy left the hospital with a lot of paper work, a container of pills and an appointment to see her physician the following month. The instructions were thorough and the discharge staff were patient and pleasant. But Marcy was still a little weak from the infection that had landed her in the hospital in the first place, and flustered by the whole experience. And, she had to admit, these days she got confused more easily than she had in the previous 83 years of her life; neither her memory nor her sight were what they used to be.
A few days later, Marcy mistakenly thought she had forgotten to take her morning medication and swallowed a day's worth all at once. The overdose nearly killed her, and she landed back in the hospital.
Her experience is not unusual, but with the renewed emphasis on improving quality of care and reducing readmissions, it has to become a lot more rare.
A study funded by the Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative indicates hospitals can accomplish that by assigning a registered nurse to oversee medication management during the transitional period between when a patient leaves the hospital and when he or she sees her primary care physician.
"Very often during that time, no one is checking to be sure that the patient is taking the right doses of the medication at the right times, or even that the patient is taking medication at all," says Linda L. Costa, R.N., nurse researcher at the Johns Hopkins Hospital and assistant professor at Johns Hopkins University School of Nursing. "And even if they meet soon with their primary care providers, there's not always a guarantee that the provider will have access to the hospital records for that patient in a timely fashion."
The research team comprised two nurses and a clinical pharmacist at Johns Hopkins Hospital. After consulting with the pharmacist on patients' medication regimens, the nurses made sure the home list of medications was complete and correct in the patients' electronic health records. They called patients 48 hours after discharge and visited patients at home within 14 days. The study found that face-to-face visits were more effective than phone calls in helping patients adhere to their medication regimens.
The results were published in August in Journal of Nursing Quality Care.
Bill Santamour is managing editor of Hospitals & Health Networks. Follow his tweets at www.twitter.com/hhnmag.