Help nurses reduce medication problems
RNs use easy reference sheets to learn and teach
When New Century Home Health had its last Medicare certification survey, the Tulsa, OK-based six-nurse agency was told its performance in classifying medications was lacking. "They said we needed to make note of drug classifications, actions, side effects, and contraindications," says Robin Treat, RN, director of clinical services.
To address that, Treat and two data-entry specialists spent 10 days in August entering more than 200 pages of information on drugs into a proprietary database system. Now, nurses and patients can get a one-page print-out of a patient's medications that includes all the information federal surveyors said was missing earlier in the year. Treat says nurses love it so far, particularly because so few of them carry drug reference guides around these days. Nurses just have too much other equipment and resources to lug around, she says.
Neil Drucker, RN, owner of home care consulting firm OMNI Healthcare in Moore, OK, also has detected the trend toward nurses carrying less explanatory material to help them educate patients and themselves. It often shows up as a problem with generic drugs in particular, he says. Many generics are not recognizable by name or appearance to nurses. That makes it harder for nurses to educate their patients on potential side effects or to point contraindications out to physicians.
Now, Treat has a way to ensure her nurses have all the information they need on a particular medication. She doesn't need to worry about whether the drug is generic or name-brand. Her computer system doesn't automatically convert a trade name to a generic name as some do. Instead, only the actual name of the medication being used is entered and printed out of the system. For instance, if a patient uses Keflex, that name is put in, not the generic name, cephalexin. For drugs that are not used commonly and have not yet been put into the database, Treat says she has an automatic notation for nurses to look up information on that drug.
Getting nurses to access and use information on drugs has been a problem for Lacretia Grant-McGowan, RN, director of MEDEX Home Health in Oklahoma City. "We give them a list of drugs and all the names used, and then just pray they use that information," she says. She knows it is an issue for state surveyors, and that patient education is getting increased attention. Her solution is a shorter profile because the four nurses at her agency also no longer carry drug references. "We have admission conferences, and a medication profile is handed out to the nurses and the patient."
It seems to help, particularly when a pharmacist sends a different medication from what the patient had last month. For example, a pharmacist may replace a name-brand drug with a generic. "Rather than ask the pharmacist, patients wait for us to come and ask us," says Grant-McGowan. "We have to know, or we have to have ready access to the information."
The computerization New Century undertook was a huge project, says Treat, but she thinks it will be worth it. Along with the information she has now, the system is expandable. For instance, she is slowly adding information on other medications that would preclude a patient taking a particular drug. "That's not always included in the contraindications," Treat explains.
The medication sheets also help with patient education because the nurse can use them as cue cards for the patient's teaching, going down the list of potential side effects and how the drug works. And not only do they help teach patients, but over time, the nurses improve their knowledge of drugs. "It is a clear benefit," says Treat. "We needed to do this, and it has worked out well so far."
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