A continuous improvement project has helped nurses in the Mother & Baby Unit at Logan Regional Hospital find ways to help mothers better understand the medications they’re taking and what they can do if they experience any negative side effects from those drugs.
Louise Stephens, RN, led the effort to help mothers better anticipate possible medication side effects.
The project helped the Logan team move from the 20th percentile nationally to the 79th percentile on HCAHPS patient satisfaction surveys, according to Louise Stephens, RN, the nurse manager for the unit.
The nursing team noticed when patients responded to the HCAHPS survey question that asks if anyone had prepared them for the possibilities of side effects from their medication, many of their patients were saying they’d received no such guidance, Louise says. The nurses wanted to focus on this area because patients should know the names of medications they are taking, the common side effects of those medications, and the intended effects of the medications. Knowing this information promotes patient safety and helps her by including her as part of the care team, she says.
The team knew they were consistently talking with their patients about medication side effects and yet somehow it wasn’t showing up in their survey scores, she says. They launched a five-month continuous improvement kata project to figure out how they could do better. A kata is a focused approach that’s used to analyze problems, test out potential solutions, and find the best ways to make improvements.
“When a patient knows the side effects to look for, she’s more likely to speak up if she has a negative side effect,” Louise says. “There're usually alternatives to medications so if a patient has a side effect she can’t handle, there're probably options available to them. This leads to patients taking their medications properly and that results in better outcomes for them.”
Before starting their kata, the nurses came up with six possible reasons that might explain why some patients didn’t feel they’d been taught about potential medication side effects. One possibility they considered, for example, was that nurses may not have been using the phrase “side effects” when they talked about what their patients might experience while taking certain medications.
They came up with some proposed solutions including some very simple things like using the words “side effects” more often when teaching. Another thing they did was to explain the possible side effects of the medication every time they gave their patients medication and then, after the third time, they asked their patients to teach back to them what side effects they might experience. They posted an education sheet on the white board in their room that explained what side effects their patients might expect on the medications they were taking and gave them the sheet to take home with them when they left, Louise says.
The team met every two weeks to review its progress and decide what ideas they would test next, Louise says.
Not content to wait for survey results which can take six weeks to come back after a patient is discharged, Louise went to patient rooms to ask the mothers about their medications to see if they’d understood what they’d been taught. That process gave the team immediate feedback about whether their approach was working.
“We want to take the best practices and integrate them into our daily work,” she says. “This is not just a project we do and then we're done, and we move on. This is how we do our work to continually improve for best practices, safety, and quality outcomes.”
Amy Campbell, women and neonatal operations director for the north geography, says she was really impressed with the rapid improvement the Logan team made by applying kata principles. She says the team consistently looks for ways to make make improvements and this is a great example of what can be done though such an approach to benefit patients.
“I’m really proud of them and I’m happy to toot their horn for them because they have done amazing systematic work and they have proven that the process works,” she says.