Promoting Medication Adherence : The Nursing Role

1. Promoting Medication Adherence: The Nursing Role By: Katey MacCormack

2. The Big Picture • For example, a patient with congestive heart failure failing to take their diuretic as. prescribed could potentially be hospitalized for fluid overload. Therefore, adding to the healthcare expenditure. • Patient non adherencewith prescription medications results in 10% of hospitalizations and 125,000 deaths per year. • 46% of Americans have chronic conditions requiring long-term use of maintenance medications Non-Adherence: New Insights. Express Scropts: Drug Trend Report. (2013). Retrieved from http://www.drugtrendreport.com/insights-and-solutions/nonadherence-new-insights

3. Causes of Non Adherence • Lack of knowledge: • Unsure how or when to take the medication • Health State • Fear of side effects • “I feel good, therefore I don’t need the medication” • Lack of support • No one to prompt or assist • Illiteracy • Cannot read or understand the instructions • Access • No access to pharmacy for refills • Cost

4. Reasons For Not Filling Prescriptions Source: Prescription Drug Use Among Midlife and Older Americans, AARP, December 2004

5. Characteristics of Non Adherence: What to look for as Nurses • Objective tests that suggest non compliance– lab tests, physical exams, vital signs, etc • Development of complications • Ex: pulmonary edema in CHF patients failing to take their prescribed diuretics • Exacerbation of symptoms • Ex: a patient on an antihypertensive regimen presenting to the ED with excessively high blood pressure after a fall at home • Repeated hospital admissions • Missed appointments • No therapeutic effect • Ex: consistently high cholesterol levels in a patient prescribed Lipitor

6. Most Common Interventions Medication organizers Electronic pagers/ timers Morisky Scale self survey

7. Implications for Nursing • Often times nurses are the members of the healthcare team communicating the most with the patient. • The nurse’s role is to advocate for her patient in order to improve their health outcome. • Nursing interventions regarding medication adherence • 1) Ongoing assessment • 2) Therapeutic Interventions • 3) Education

8. Asses the patient’s perceptions of their own health problems • Some patients believe they are “cured” because they feel well at the moment • What does the patient believe is causing his/her disease symptoms? • Assess religious beliefs or practices that could affect health • Determine reasons for past issues with non compliance • Ask patient to bring prescriptions to the appointment • Asses blood levels Ongoing Assessment

9. Develop a therapeutic relationship with the patient and their support systems • Trusting relationships can enhance adherence • Make the patient a “co-manager” of their own treatment • Gives the patient a sense of control over their own treatment • Adjust therapy to the patient’s lifestyle • Increase supervision • Home health aides, telephone monitoring, frequent visits Therpeutic Interventions

10. Collaborate with other healthcare professionals regarding best methods for educating • Assess patient’s level of literacy and ability to understand instructions • Tailor to patient’s level of knowledge by use of visual aides or assistive programs • Take language barriers into account • Teach not only the patient, but the patient’s support system • Explore community resources • Serve as a bridge between the patient and the healthcare provider • Actively assess patients knowledge regarding dosing, timing, and reasons for use of medications Education

11. References • Fung, B.(2012, September 11). The $289 Billion Cost of Medication Noncompliance, and What to Do About It. The Atlantic. • Non-Adherence: New Insights. Express Scropts: Drug Trend Report. (2013). Retrieved from http://www.drugtrendreport.com/insights-and-solutions/nonadherence-new-insights • Reasons for Medication Non-Adherence. MTS Medication Technologies. (2012). Retrieved from http://www.mts-mt.com/learning/medication-adherence the_reasons_for_non_adherence/ • Zurlinden, J., & Gulanick, M. (2012). “NANDA: A patient’s informed decision to not to adhere to a therapeutic recommendation”. ElsevierNursing Care Plans, 5th edition.

12. Reflective Note In all of the orientations I have done for my co-op jobs, the most common way that information is passed on is through a PowerPoint presentation. I chose this genre because I believe it is the most effective method for getting the point across. A PowerPoint presentation can be shown to a large group of people in one room with one presenter, therefore maximizing effectiveness regarding getting the information across. There are also many different angles that can be taken when creating the presentation including use of visual aids and strategic wording to keep the audience captivated. When it comes to creating a presentation for other medical professionals it is important to keep the presentation concise yet informative. Sine the audience is full of people with the same common knowledge it is important to be sure not to repeat information that the audience will already be aware of because this will lose the attention of the audience. It is essential to also remain factual and to the point. I think I did a good job of this in my presentation. I feel I remained informative and factual yet concise. In terms of the content, I wanted to focus on the nursing role. In order to do that, I had to make a point regarding the importance of promoting medication adherence beyond the usual patient care reasons. Nurses should be thinking not only in terms of patient care, but also in terms of innovation and change for the future. Understanding the reasons for non adherence can help to fix the problem. The specific nursing interventions in slides 8-10 are the big takeaways from the presentation because that is what is gong to fix the problem. A presentation like this would most likely be found at a meeting in a doctor’s office or possibly at an educational institution geared at raising health outcomes for patients. Medication adherenceis an issue that affects all areas of healthcare, so it could really be addressed anywhere. I would like to include this piece in my final portfolio because I feel like it accurately portrays the professionalism I am capable of creating which is an important skill for my career.