- A noncompliant patient is not always the root of medication non-adherence. Instead, lacking patient medication education can keep patients from understanding their medications, causing adherence errors along the way.
What is the medication dose? How often should the patient take the drug? Should the patient take the drug on an empty stomach or after a meal?
These are questions that many patients have but don’t always have answered, resulting in medication errors and sometimes adverse patient safety events. Research shows that nearly 63,000 pediatric patients under age six experience a medication safety event at the hands of their parent caregivers due to inadequate information.
Strong patient education and better medication prescribing and organization processes can help alleviate these problems.
At Seattle Children’s Hospital, Rod Tarrago, MD, wanted to eliminate any medication issues among his pediatric patient population. In his role as Associate Chief Medical Information Officer and Medical Director of Medication Safety, Tarrago spearheaded a three-part medication safety improvement campaign.
The overhaul began with some work on the medication reconciliation program. Tarrago and his medication safety team also integrated a new e-prescribing platform.
“We had a home-grown system that didn’t work very well,” Tarrago told PatientEngagementHIT.com in a recent interview. “Now we’ve taken Cerner’s medication reconciliation process in our inpatient setting. Along with that we implemented their e-prescribe solution. That initially was a separate project but ended up being a combined effort.”
However, an overhaul on the provider side was not going to be enough, Tarrago and his team found. Seattle Children’s also needed to help pediatric patients and their parent caregivers understand their medications to drive proper medication adherence and safety.
“As we started looking at that planning for these two projects, we’d gotten a lot of feedback from our patients and families that the documents they received upon discharge were a little bit lacking,” Tarrago said, suggesting that there wasn’t enough education substance to their patient medication safety program.
The hospital previously used a home-grown report with custom printed patient lists that included medications and some instructions.
When those printouts worked, they worked well, Tarrago acknowledged. But all too often the lists were inaccurate – an issue that the medication reconciliation and e-prescribing projects fixed – and they weren’t user-friendly or navigable.
“Our patient and family advisory council said that even when the list was accurate, the layout and format wasn’t very patient and family friendly,” Tarrago said. “Usually when patients went home, if they kept the list, they would use it as a template to put information into a calendar view to know when to take what.”
Tarrago and his team answered patient requests with a tool called Meducation, the third step in their medication safety overhaul.
Using this technology, Tarrago cut out the middle man and began offering the calendar interface that patients were asking for. In addition to meeting patient interface preferences, Meducation also offers medication instructions in 22 different languages, meeting the needs of the non-English-speaking population at Seattle Children’s.
Although the hospital has only been using the technology for a short time, Tarrago says the patient and family advisory council has offered enormous support.
“We actually got a round of applause when we presented the tool,” Tarrago recalled. “Patients and families were very happy that we had made this change. That is not to say there weren’t suggestions for improvement, but families were ecstatic we were on our way.”
Some of those suggestions include personal interface preferences that Tarrago says his team is working on. Being able to make a more customizable interface is critical for offering individualized treatment, he explained.
Tarrago and his team also have their own suggestions and are collaborating with Meducation to improve.
“The tool relies on some standard algorithms to fit into certain timeframes,” Tarrago said. “Because we went live at the same time with these big three solutions, all of that customization didn’t get done and may have interfered with using the tool to the fullest.”
For example, recording a medication dose is still a little wonky, Tarrago explained. If he writes a blood pressure medication for a small child via a liquid, he might prescribe 1.3 milliliters. Because adults don’t usually take that dose, the tool hasn’t learned to record the dose properly.
And if Tarrago adds specific instructions – like taking the medication through a specific tube every eight hours but holding the drug if the blood pressure is a certain level – all of those things interfere with the tool’s interface. The tool is still learning to meet their unique pediatric needs, Tarrago pointed out.
Tarrago and his team also share concerns about the customization features that his patients have expressed. But instead of simply wanting the interface to look a certain way, Tarrago needs the tool to work for complex patients who take a myriad of medications.
“One of the challenges we’ve encountered is how to build something that applies to a relatively healthy child who needs only one medication and to a complex, very sick bone marrow transplant patient who takes 30 different medications many times a day,” Tarrago posited. “That’s the next challenge.”
The solution may be adopting an entirely different version of the technology, Tarrago offered, or creating a more complex interface that could cater to both relatively healthy children and complex patients.
Regardless of the solution, however, Tarrago maintained that he and his team must continue to collaborate with the patient advisory council to make sure the tool meets all of their unique needs. Not doing so would create a complex tool that might not even work.
Allowing for more customization will be an iterative process, Tarrago continued. As he and his team learn more about patient medication education needs, the technology Tarrago leverages will shift into a new, more useable shape.
“One of the biggest things is that this is an ongoing process that we’re going through,” Tarrago concluded. “It really is about learning from each other and keeping patients at the center. Historically, medication reconciliation has been fragmented. In the end, it’s about making sure the patient is taking the right medicine, at the right time, for the right disease.”