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Improving Discharge Medication Education: Consideration of Health Literacy and Language
Stephanie S Squires1, Alaina K Kipps1, Sheila Gamuciello2
1Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California.
Insights
A new medication adherence aid (MAA) improved discharge care for children with medical complexity, increasing access for non-English speaking families. This patient-centered approach enhanced medication safety post-hospitalization.
Area of Science:
- Pediatric Healthcare
- Patient Safety
- Health Literacy
- Health Disparities
Background:
- Medication errors are common in children post-hospitalization, particularly for those with medical complexity.
- Risk factors include low parental health literacy and non-English preferred language (LOE).
- Discharge medication lists often require improvement for better parental understanding.
Purpose of the Study:
- To develop and implement a low health literacy, language-concordant discharge medication adherence aid (MAA).
- To provide the MAA to over 95% of patients discharging from the acute care cardiology unit (ACCU).
- To improve medication adherence and reduce errors for vulnerable pediatric populations.
Main Methods:
- A multidisciplinary team developed a bedside nurse-generated MAA intervention.
- The MAA was designed to be low health literacy and language-concordant.
- Medical record review tracked the weekly average of MAA provision; statistical process control charts analyzed trends.
Main Results:
- The weekly average of patients discharged with an MAA increased from 21% to 75% within six months.
- This improved rate was sustained from July 2022 through October 2023.
- Language-concordant MAA provision was equitable, with 76% of LOE patients and 74% of English-preferred patients receiving an MAA.
Conclusions:
- A language-concordant, patient-friendly MAA was successfully implemented for 75% of discharging families from the ACCU.
- Piloting the intervention with a small nursing group enhanced implementation and sustainability.
- This intervention demonstrates a successful strategy to improve medication safety for diverse pediatric populations post-discharge.
Background And Objectives:
Medication errors occur frequently to children after recent hospital discharge, with known risk factors of medical complexity, low parental literacy, and parental preferred language other than English (LOE). Focus groups with parents of children with medical complexity at our hospital identified our discharge medication list as needing improvement. Therefore, our team set out to provide a low health literacy, language-concordant discharge medication adherence aid (MAA) to more than 95% of patients discharging from our acute care cardiology unit (ACCU).
Methods:
We formed a multidisciplinary group and developed an intervention whereby each patient's bedside nurse would generate a low health literacy, language-concordant discharge MAA and assessed the weekly average of patients discharged with an MAA in their preferred language via medical record review as our primary outcome measure, with subset analysis of MAA provision by preferred language to monitor implementation. Statistical process control charts were used to assess the impact of interventions over time.
Results:
During the intervention, the weekly average of patients discharged with an MAA increased from a baseline of 21% in May 2022 to 75% and was sustained from July 2022 through October 2023. There was comparable percentage of LOE patients (76%; 94 of 123) to English-preferred patients (74%; 459 of 622) who received a discharge MAA.
Conclusions:
Over a 6-month period, we implemented a language-concordant and patient-friendly MAA for 75% of discharging families from the ACCU. Piloting the intervention first with a small group of nurses improved our success during both the intervention and sustainability period.
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