Good clinical outcomes are a lot like preparing a meal.  It is not simply about putting the ingredients in front of your dinner guests and expecting them to eat.  One must follow a recipe and eventually the ingredients are synthesized into a complete experience.  Likewise, patient care staff cannot simply tell a patient to take a medication without communicating important details related to the chosen course of treatment. 

Unfortunately, in the recipe for good clinical outcomes, explanation about medications is a step that is oftentimes skipped.  In fact, according to an FDA study, roughly one in three patients leave with no instructions on how to take medications prescribed to them.  Furthermore, about half of all patients will not take their medications correctly or will discontinue their medications.   As a result, not only will healthcare providers see patients who may not get better, they will experience lower scores on their patient satisfaction and HCAHPS surveys.

Through the years, HealthStream Research has discovered many best practices to improve communication about medication.  In general, these best practices can be grouped into the following categories: address language/communication difficulties, provide staff with tools and training, and improve frequency of communication. 

Address language/communication difficulties/deficiencies

1) HealthStream Reserach strongly recommends that any staff involved in direct patient care always explain medications.  If this can be done while sitting down or by providing a reassuring touch, patients will be more likely to feel that the staff member has taken the necessary time with them to explain medications.

The following are additional practical strategies for improving scores in this area:

• Require patient care staff to provide patients with verbal and written instructions for the most common medications used
• Consider training for staff to assist them in clearly explaining medications
• Sit down with patients when explaining things.  This body language tells patients that the staff member is focusing on the patient and is willing to take the necessary time to make sure that the patient understands medications  

The fundamental reason that patients want patient care staff to explain medications is for reassurance.  Explaining generally calms fears and anxieties, and at the same time has positive effects on the perceptions of pain, kindness, and responsiveness.  This is why it is highly correlated to overall patient satisfaction, and efforts to improve ratings for this attribute will cause increases in other areas as well.

2) Many patients may have language or conceptual difficulties when staff tries to explain medication to them. It is important to realize that the use of charts and diagrams enhances the communication process. The way nurses and doctors say something is as important as their choice of vocabulary.  It would be beneficial if they:

• Use tact and consideration when explaining medications to patients to avoid causing anxiety
• Be honest and straightforward, and demonstrate respect and concern for patients
• Legitimize patients’ fears and embarrassments, which are natural emotions 
• Reassure patients by demonstrating respect and empathy
• Provide patients with an opportunity to ask questions
• Talk directly to patients when working with interpreters or members of their family
• Verify understanding of the intended message by rephrasing the message and, if necessary, asking patients to repeat 

Careful use of body language can greatly enhance communication, leading to better understanding and trust between staff and patient. Since the main goal of communication is mutual understanding, listening is just as important as speaking. By learning to listen effectively, your staff can learn to modify their speech to match the needs of the patient. The benefits of listening and observing include enriched communication and patients who are dignified partners in their own care.

Provide the staff with additional tools/training

1)    A very successful best practice is called the “Nurse Toolkit,” designed to help nurses find information about an unfamiliar condition or diagnosis. Using the “Toolkit” lets staff members quickly provide information to fellow colleagues and to patients.

A specialized clinical toolkit gathers together textbooks, patient education resources, drug resources, databases, and journals most relevant to clinical nursing. This information is then accessible through an internal web site for quick access. Among other resources, the toolkit should contain the Lippincott Manual of Nursing Practice and Lippincott’s Drug Guide, as well as provide access to online journals that are unique to nursing.

HealthStream Research encourages nurse managers and administration to get involved in creating a “Staff Toolkit.” This tool will provide staff members with a wealth of knowledge “at their fingertips” that can be used for training, assist in ongoing education at the hospital, and provide patients with timely answers to questions about their diagnosis, treatment, and course of care.

2)    Institute video-taping as a means of effecting better communication skills from staff.  This is an excellent way to hold staff members accountable for communication skills and to determine areas where staff members require training.  When reviewing the tapes, staff and administrators should be looking for effectiveness in both legal informational and social influence models of communication.  Staff members who are successful in using both models generally cover the aspects of allergic reactions to medicines and their side-effects better and are generally more successful in getting patients to buy-in to their treatment, resulting in better health outcomes.

Improve frequency of communication

1)    HealthStream Research recommends that staff focus on communicating more frequently and effectively with patients. Asking questions, listening carefully to the answers, and discussing issues that could prevent further distress have positive effects on calming patients’ fears and anxieties. Patients should also be encouraged to ask questions and be given the feeling of an open communication environment where they are active participants in the treatment and care process. Family members who normally care for these patients may be helpful with suggestions to help calm them and allay their fears.

Simply by initializing communication about medications, a healthcare provider is gaining a leg up on many competitors.  By instituting some of the best practices discussed above, staff members will be able to deliver a new level of healthcare.  Not only will patients be happier and have improved perceptions of the staff in general, but patients will be healthier as a result of lower medication drop out. 

2)       It is important that patient care staff take the opportunity to discuss medication with patients before they leave and to do so in a way that encourages proper usage and discourages drop-out.  Joanne Desmond and Dr. Lanny Copeland, authors of Communicating with Today’s Patient, have laid out the following checklists for ensuring proper communication and retention of medication information and how to ensure patients “stay the course” in their treatments.

The following practices were recommended to ensure that patients receive and understand medications they will be taking:

• Identify a patient's familiarity or experience with a medication
• Personalize the body parts being referenced; use "your lungs" as opposed to "the  lungs"
• Avoid information overload by limiting key points or clinical language to a one per sentence rate 
• Use pauses of about two beats between important information to allow the patient to absorb what is being said

It is important to ensure that patients are able to continue taking medication properly and to discuss side effects up front.  Be candid about side effects and use statistics to back up the likelihood of developing a common side effect.  Be sure to let the patient know if changes to treatment can be made to find a balance between side effects and effective treatment.  By doing so, patients feel less frustration with side-effects and have more confidence in the patient care staff’s competency.

Excellence in healthcare is about more than what happens within the walls of your hospital—it’s just as important to ensure continued excellence once the patient is no longer under your direct supervision.  The greater the understanding of medications by the patient, the greater the compliance with your recommended treatment plan will be.