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Medication Safety Series: Take Charge!
Nurses have read the statistics on the numbers of prescription medications seniors take each day and the pitfalls and diverse problems that occur as a result. Various scenarios contribute to this problem: multiple healthcare providers prescribe medications; the use of over-the-counter products and herbs or alcohol cause medication interactions; and patients increase, decrease, skip, or repeat doses. When medications are not taken correctly, an increase in the number of physician or emergency department visits and hospitalizations results.
Patients who come to a rehabilitation unit after joint replacement or hip-pinning surgery, stroke, or for treatment of other conditions may be prescribed medications that differ from the drugs they were taking at home. These patients and their families need to learn how to safely take their new medications.
This presentation describes how five nurses developed a medication safety program consisting of four segments: Making Your Medication List; Talking to Your Healthcare Team About Your Medications; Safely Storing, Taking, and Destroying Your Medications; and Knowing the Difference Between Allergies, Side Effects, and Interactions. This article also describes the development of the script and PowerPoint program, lessons learned from the first presentation, and implications for rehabilitation nurses.
The information presented in this series can help patients and families take charge of their medications. The team of community educators who wrote this article encourages the integration of this program into readers’ local patient communities because standards of care and resources vary in the communities that nurses serve.
Seniors, on average, take 5 to 10 prescription medications each day. Often the medications are not taken as prescribed (doses are increased, decreased, skipped, or repeated). Seniors’ medications interact with over-the-counter products, supplements, herbs, or alcohol, resulting in physician or emergency department visits or hospitalization, which complicates overall health care (Budnitz et al., 2006). Seniors may not inform all of their healthcare providers about medications prescribed by others. They may use different pharmacies to fill prescriptions, overriding the safety check of pharmacists (Pervin, 2008).
Five nurses who prepare presentations for community seniors discussed the problem and began to identify the information seniors need to know to safely use their medications. The discussion led to the development of the Medication Safety Series, which comprises four PowerPoint presentations. The nurses envisioned this information would give seniors (or patients) and their families (or caregivers) the knowledge to take charge of their medications. Often families are concerned when they observe a decline in their family member’s overall health. Including family members in a medication safety program can be a positive experience and give families the tools to support their loved one.
Identifying the Audience
We identified our audience as seniors, family members, and caregivers. Noting the physical changes in vision, hearing, and memory that occur in mature adults, we used large, bold print and bullet points for PowerPoint slides and handout materials. A microphone was used when needed. Major points of the program were presented at the beginning as objectives or questions to be answered during the program. Principles and facts were emphasized during the presentation and summarized or reviewed as questions at the end. The audience was encouraged to ask questions and share their experiences, and the presenter evaluated the audience’s nonverbal responses and addressed questions. The information also was presented using different words or examples. Presenters remained available after the presentation to answer further questions.
Our first step was to identify information pertinent to medication safety. This entailed creating a series of drafts that listed the information in outline format and then circulating drafts for additions and corrections. The information was sorted and four categories were identified: the need to carry an up-to-date list of medications; talking with the doctor or pharmacist; storing, taking, and disposing of medications; and interactions, allergies, and side effects of medications. A script was developed for each category. The scripts were circulated with ideas for visuals to illustrate the script.
The four segments of the series are
Making Your Medication List
Talking to Your Healthcare Team About Your Medications
Safely Storing, Taking, and Destroying Your Medications
Knowing the Difference Between Allergies, Side Effects, and Interactions.
Each segment is independent. We envisioned that each segment would last 20–30 minutes, with time allowed for questions and audience participation. If the allotted presentation time was 1 hour, two segments could be shown with a break between them for questions. A segment could be presented in tandem with another medical professional such as a pharmacist or physician. The segments do not cover information about specific medications or classes of medications.
We promote the use of resources within communities to embellish these presentations. Introducing your audience to the healthcare team that will be available for follow up also is encouraged.
Making Your Medication List
The information presented in Making Your Medication List covers the importance of making such a list, the information that should appear on the list, where to find the information (The National Women’s Health Information Center, 2006; Wooten, 2006), and who should have a copy of the list and why. Encourage the audience to bring their prescription medications so they can make their list or update their current medication list if they have one. A list of sample medications should be available so attendees can practice making a list. Participants should then compare their medication list to “What Should Be on Your Medication List?” (Figure 1).
Talking to Your Healthcare Team About Your Medications
This segment stresses the importance of a yearly review of current medications with the healthcare team, discussing questions that should be asked about any new prescription medications (U.S. Food and Drug Administration, 2005), the need to make and carry a medication list, and the information the list should contain. Emphasize that patients should give a medication list to all healthcare providers to prevent duplicate prescribing.
Because seniors and their families seek information about medications from multiple sources, the presentation discusses the need to identify reliable resources, such as written and verbal information from a pharmacist, package inserts, and online sources that are current and research-based (Haupt, 2006). Seniors should know that unreliable sources include advertising that sells the product and personal testimonials.
Because the high cost of prescription medications is of great concern to seniors, suggestions to reduce costs, such as using generic instead of brand-name medication, are presented (Hanink, 2007).
It is helpful and safer to obtain all medications from the same pharmacy. The audience should be reminded to check the medication label and tablets when picking up a prescription from a pharmacy. If the tablets are not the same size, shape, or color as their last prescription, they should speak to the pharmacist to verify that this is the same medication (albeit from another manufacturer if generic). Generic brands often are substituted to save costs. However, every purchaser has the right to clarification when substitutes are used.
Safely Taking, Storing, and Destroying Your Medications
This segment presents information on three topics: the five steps to taking medications as directed; the safest and best place to store medications (NIH SeniorHealth, 2004); and the proper methods to dispose medications (California State Board of Pharmacy, 2006; Milloy, 2007). The effects of not taking medications as prescribed also are discussed (NIH SeniorHealth).
Knowing the Difference Between Allergies, Side Effects, and Interactions
This segment discusses definitions of these terms and provides examples of allergies, side effects, and interactions; what to do about them; and types of medication interactions and examples of common interactions (Bowers, 2002; Lanca, 2008; MedlinePlus, 2008; Samuel, 2007; Shiel & Hecht, 2004). The importance of placing information about allergies, side effects, and interactions on a personal medication list is highlighted.
Throughout the segments, the audience is encouraged to ask questions about their medications, side effects, or interactions with their healthcare provider and pharmacist.
After the content of each of the four segments was agreed upon, the PowerPoint programs were developed. The content for each segment was divided into topics and information on the topic was placed on slides using bullet points and large, bold print against a white or light background for easy reading. Clip art was added to some slides to illustrate the content and add color.
Animation was added to selected slides to reveal the segment text as it was discussed. An example was the detailed information found on the medication label (in particular, the warning information).
For the sequence on disposing medications, a friend posed for digital photos of the proper procedures to dispose of pills, liquids, and blister packs. The photos were incorporated into the program.
The script was added in bulleted format, covering the main ideas below each visual, and was printed as a booklet for presenters. The presenter could add information, examples, and experiences to the presentation.
We reviewed the PowerPoint presentations for accuracy; clarity; amount of information; and use of pictures, animation, and clip art. Emphasis was placed on ease of understanding. After minor adjustments, we were ready to present the programs.
In November 2007, we presented “Making Your Medication List” and “Safely Storing, Taking, and Destroying Your Medications” at our parish. The presentation was advertised for 3 weeks in the church bulletin, along with several other parish events. Three of the five nurses had presented health topics in the parish in the past to audiences of 8–12 people. This time, four of the five nurses, Sister Rita, who coordinates parish activities, and two other women were present. Although we were disappointed with the low turnout, both women in our audience said they learned new information and reviewed some things they already knew.
When scheduling a class in the community, the presenter and group requesting the class should discuss the type of audience (e.g., age, ethnic group, or language-related needs) and the interest in the topic. This will allow the presenter to tailor the program to the audience. We recommend that reservations be required to get an estimate of the number of people interested in the program. Advertising the class through flyers, newsletters, public television, and word of mouth is advised. A prepared class summary can be used to promote the presentation.
Presenting two segments in a 1-hour time period was too much information. The time did not allow for audience participation and sharing of examples of how participants remember to take their medications or items on their medication list. In the future, each segment will be a presentation in itself, requiring 40 minutes for presentation and a question-and-answer period.
Show and Tell
The presenters brought items such as outdated bottles from their medicine cabinets and shared their stories about medication problems concerning family and friends.
The presenters had limited experience with PowerPoint and slide animation, but after a short practice session, they found the technology was easier to use than they thought.
Seeing the presentation on a large screen is different from viewing it on a small computer screen. One slide had examples of warnings found on a medication label. Each warning (e.g., take with food, stay out of the sun, avoid dairy) was in a different-colored block. The blocks of darker colors were difficult to read and will be replaced. We decided this slide should be animated so each warning can be shown when discussed.
In community classes, readiness to learn primarily is dictated by the people who choose to attend a presentation either because of their own interest or at their healthcare provider’s recommendation.
Various methods can be used to evaluate an educational program. In each segment of the Medication Safety Series, the objectives are phrased as questions to be answered during the presentation. These questions can be used for discussion at the beginning of the presentation. The same questions can be asked during or at the end to evaluate if the participant understands the content. The questions can be used as a verbal or written pre- or posttest. The presenter uses audience comments, questions, and nonverbal communication to gauge understanding.
After the presentation, each audience member is asked to identify the one thing they learned from the presentation. A formal evaluation tool asks if the objectives were met and their questions were answered, if they would recommend the class to a friend, if the presenter was effective, and if they have any recommendations for the presentation (Figure 2)
We will continue to revise the presentations as new information becomes available, and we look forward to presenting another segment of the series at the parish.
Developing a program such as the Medication Safety Series is time consuming; it took 1 year to develop the entire program. The five nurses now can use any one of the complete programs in the community.
Implications for Rehabilitation Nurses
Rehabilitation nurses educate patients, families, and caregivers on many topics related to their injury/illness, its outcome, and complication prevention. A patient’s medications may change after a hospitalization. In many cases, it has been a long time (if ever) since a patient, family, or caregiver has reviewed medication safety practices and precautions. The flexible design of the Medication Safety Series is convenient and consistent, providing a variety of presentation modalities.
In the Association of Rehabilitation Nurses (ARN) Strategic Plan under Professional Development, the first objective is “Increase the diversity of ARN delivery methods for knowledge dissemination” (ARN, 2007). The Medication Safety Series can serve as a model to develop other educational programs for use by patients, their families and caregivers, and the communities served. Rehabilitation nurses can use these programs in the community at long-term care or assisted-living centers, community or senior centers, or other group and organizational gatherings, thereby meeting the ARN Strategic Plan goal, “To reshape health care by integrating rehabilitation nursing concepts into the care for all people” (ARN).
To allow for differences in standards and resources in any community, it may be necessary to tailor this program to audiences. “Canned programs” that are general have their place. The success of your program will be enhanced if your patients believe this material is directed to their needs. Using examples familiar to participants, encouraging feedback and questions, and supplementing the resources they have at their disposal will create more interest, involvement, and compliance. The goal for our programs is to enable our patients and families to take charge of their health care.
About the Authors
Elizabeth Yetzer, MA MSN CRRN, is a community nurse educator at Talbert Medical Group in Anaheim, CA. Address correspondence to her at firstname.lastname@example.org
Karen Blake, RN, is a community nurse educator at Talbert Medical Group in Anaheim, CA.
Nancy Goetsch, MSHS RN, is a volunteer community worker with the Office on Aging, Down with Fall Coalition of Orange County, CA, and Garden Grove Community Center.
Mary Shook, BSN RN NP, is a community nurse educator at Talbert Medical Group in Anaheim, CA.
Marilyn St. Paul, BSN RN, is a community nurse educator at Talbert Medical Group in Anaheim, CA.
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