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17 Executive Briefing Nurses and Hospital Medication Management — Improving Patient Care and Outcomes M edication errors are an all-too-common problem in the U.S. In fact, they affect nearly 5 percent of the na- tion's hospitalized patients, according to the Agency for Healthcare Research and Quality. In addition to being det- rimental to patient care, medication errors also pose a signifi- cant financial risk to hospitals' bottom lines — the Network for Excellence in Health Innovation estimates preventable inpa- tient medication errors can cost roughly $16.4 billion annually. Adverse drug events can also lead to readmissions. For instance, roughly 19 percent of discharged patients experi- ence an adverse event post-discharge, and two-thirds of those events are attributable to medications, according to a study in the Annals of Internal Medicine conducted in the early 2000s. Those adverse events can increase the risk of readmissions, which can have a negative impact on patient outcomes and hospital finances. Medication management and education are crucial for pre- venting adverse events and readmissions. Such initiatives can also affect patient experience scores given that three questions on the HCAHPS survey are related to communication about medication information. Medication management influences patient outcomes, patient experience and cost. Medication management sits on a unique intersection of metrics that affect patient care and reim- bursement in the value-based payment world. As such, it has received more attention in recent years from hospital leaders looking to improve three key areas at once. Challenges Associated with Effective Medication Management Proper medication management has become difficult for providers, according to Katherine Kenny, DNP, RN, associate dean of academic affairs at Arizona State University's College of Nursing & Health Innovation and director of research and professional practice at Dignity Health's Chandler Regional Medical Center. "Today, one of the biggest issues is knowing the names and classes of medications," Dr. Kenny says. Several formulations of the same medication are available on the market under different trade names, complicating medication management for nurses and other clinicians. Medication reconciliation involves reviewing a patient's complete medication regimen to ensure no drugs are duplicates or unnec- essary, and the process has become more important of late. "Critical thinking with medication reconciliation is one of the key processes that nurses perform upon admission to the hos- pital and upon discharge," Dr. Kenny says. Patients are coming into the hospital with an increasing num- ber of chronic illnesses that require more medications. In ad- dition to critical thinking, seamless coordination of care is also imperative for effective medication reconciliation. Sometimes, there are duplicates of medication classes or medications that shouldn't be taken together — however, in the case of siloed care, it's possible that multiple providers may not notice risky drug combinations until the patient is admitted to a hospital. Several players are involved in the sport of medication man- agement: the physician, nurse practitioner or physician assis- tant who prescribes the drug, the pharmacist, and the patient. But perhaps the person in the hospital with the most integral, influential role in the process is the front-line nurse. "The nurse is truly the last person at the end point of the trail before medication gets to the patient," Dr. Kenny explains. "It's a major role; no one else in the hospital has that responsibil- ity…they are uniquely situated to make an error but also to prevent an error." How to Support Nurses and Optimize Medication Management Supporting hospital front-line nurses with new medication learning tools can be an effective way to prevent errors, im- prove medication management and thereby bolster patient care and patient experience scores. Certain tools help nurses stay up-to-date and sharp on new medications, all of which drives increased confidence among nurses as they interact with patients. Hospitals that make these types of resources available, and make them part of the core lifelong learning process for the nursing team, are in a good position to prepare their staff to do a better job with medication management overall. TRC, a medication learning company, now offers Nurse's Letter, an online medication learning tool that aims to "help improve care, outcomes and medication learning through concise, trusted, evidence-based recommendations and education," says Sherri Boehringer, PharmD, vice president and senior editor of TRC. Each monthly edition of Nurse's Letter features at least 10 short articles which provide advice on new medications, important trial results, proper medication administration, medication safety and strategies to increase medication adherence. The monthly content also contains drug therapy comparison charts and patient handouts in English and Spanish to help patients stick with their medication regimens. The whole publication is written by pharmacists, vetted by nurses and is free from pharmaceutical influence and any advertising. Sponsored by: