Running head: FINAL SUMMARY REPORT

Final Summary Report

Michelle Duesberry-Woody
Bon Secours Memorial College of Nursing
Synthesis of Nursing Practice
NUR 4242
Wendi Liverman

On my honor, I have neither given nor received aid on this

assignment or test, and I pledge that I am in compliance
with the BSMCON Honor System.

Final Summary Report

For effective medical treatment, ambulatory patients need to use
medications as directed (Chuang, Lin, Wang, & Cham, 2010, p. 337). It is
important that the staff involved with direct patient care has an
understanding of these medications, and are able to provide education for
those in their care. The goal of this project was to help improve the patient

medication education at the Gloucester Mathews Care Clinic. Many patients

who receive care at the clinic have little to no knowledge of their
medications, and this project was designed to assist with increasing the
understanding of the medications that they take.
The medication education process in the clinic needed improvement.
Patients often came to the clinic with a complete lack of knowledge of the
medications they are taking or why they are taking them. In order for staff
to provide better medication instruction, they would also need medication
education in some cases. A medication sheet with the fifty most prescribed
medications in the clinic was created as a reference. This sheet contained
the classification of the medication, most common uses, and the trade and
generic names. Staff and volunteers were instructed on the location of the
reference, and they were educated on how to use the sheet. 40 million
Americans cannot read general consumer health information, and 90 million
have difficulty understanding and acting upon this information, and
Gloucester is no exception to those statistics (Chuang et al., 2010, p. 337).
Chuang and his fellow researchers used pictographs for their study, but
verbal instructions seemed to be a better way for clinic workers to convey
the information (Chuang et al., 2010). A study conducted at a teaching
hospital in New York had success with a verbal explanation on discharge
instructions from their physicians (Makaryus & Friedman, 2005). If the staff
member can give simple verbal instructions on medication use, then the
patient may have a better understanding on their medication regimen.

FINAL SUMMARY REPORT

Patients knowledge of the diagnosis and treatment plan is an integral

component of patient education and is a central part of the Patients Bill of
Rights (Makaryus & Friedman, 2005). That is why this project is so
important. It initially began a bit ambitious. The goal was three fold. The
first goal was to have the medication reconciliations correct to ensure that
the medication education was given on the correct medications. The second
goal was to increase staff/volunteer knowledge of medications that are most
commonly prescribed in the clinic. The third goal was to increase patient
knowledge of their medications. The patients were required to bring their
medications with them to the clinic, or they would not be allowed to have
their appointment with their provider. Patients were called prior to their
appointment, and they were notified of this change. This change was met
with little resistance. Patients adapted in about two weeks to this change.
During the call about the prescriptions patients were also instructed to arrive
15 minutes prior to their appointment. This was met with some resistance,
because they were less likely to show up 15 minutes early for the medication
counseling. The patients were very receptive to staying following their
appointments to go over their medications, but almost none of the patients
came early. The goal of cleaning up all of the medication reconciliations
had to be abandoned, because there was not enough time available. The
staff was very glad to have the quick reference guide for the most prescribed
medications in the clinic. It helped them to be able to know which generic
medications were the same as the trade, and several of the staff voiced their

FINAL SUMMARY REPORT

appreciation for the list. The list was placed in the triage room for ease of
access, and the staff was instructed on the location of the sheets.
The second cycle is proving more focused on the education aspect.
Sometimes an invitation is extended into the appointment to do the
counseling if time allows, especially by the nurse practitioner at the clinic.
Most often the education occurs after triage before their appointment to go
over their medications with them. If counseling does not occur in between
triage and the appointment, then it often occurs following the appointment.
A nurse is generally the one who will go through the medications with the
patients. Sometimes the medical assistants will do the medication
instruction if none of the nursing staff is available. Since the process seems
to be streamlined at this point, then it will continue this way until the end of
April.
This project has been very eye opening. The first lesson learned is not
to be overambitious in the beginning. Stay focused on completing one task,
and then move on to the next after the first task is completed. Secondly,
many individuals are happy to change things like their education habits if
they are given an easy to follow method, and they themselves are instructed
on the change. This project appears to be successful thus far. The director
of patient services is in charge of all of the nursing staff at the clinic. She
was very excited from day one, and she continues to be delighted by the
results. The triage staff, RNs and MAs, continue to verbalize appreciation for
the reference list. The nurse practitioner at the clinic utilizes the services

FINAL SUMMARY REPORT

regularly, because she believes that understanding medications is vital for

each patient. The physicians seem not to have an opinion either way.
Continuing the project should provide more patients with education over the
long run. The changes for the medication education have already occurred,
but the changes for the medication reconciliations still need to occur.
Catching errors at the beginning of each appointment is working since the
patients now bring in their medications. There will need to be another
strategy for updating medication reconciliations for patients that do not have
an appointment. Overall this has been successful, and there has been a
large amount of learning that has taken place for all individuals involved.

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6
References

Chuang, M., Lin, C., Wang, Y., & Cham, T. (2010, June). Development of
Pictographs Depicting Medication Use Instructions for Low-Literacy
Medical Clinic Ambulatory Patients [supplemental material]. Journal of
Managed Care Pharmacy, 16(5), 337-345. Retrieved from
http://www.amcp.org/data/jmcp/337-345.pdf
Makaryus, A., & Friedman, E. (2005, August). Patients Understanding of Their
Treatment Plans and Diagnosis at Discharge. Mayo Clinic Proceedings,
80, 991-994. Retrieved from
http://internal.medicine.ufl.edu/files/2012/07/5.17.04.-Help-patientsunderstand-their-hospitalizations.pdf