Cardiovascular Disease and Patient Medication

Does Nurse Led Medication Education Improve Medication Compliance and Reduce Errors?

Cardiovascular disease (CVD) costs an estimated $444 billion per year in the United States (US). 83.6 million Americans have been diagnosed with CVD and of those, 735,000 patients have a myocardial infarction (MI), or heart attack, every year. 210,000 of those patients are likely to have another CVD event in their lifetime (Bansilal et al., 2016). According to Goss et al., acute coronary syndrome (ACS) patients have a higher rate of death after hospital discharge due to recurrent ischemic events (2017). The use of guideline directed medications, when used appropriately, has been shown to reduce the risk of death by 50 percent (Bansilal et al., 2016).

Many patients are on multiple medications to treat an assortment of conditions (polypharmacy). Cardiovascular medications are lifesaving medications and stopping these medications can put a patient’s life at risk. CV medications are very important to prevent poor patient outcomes, yet there are patients who stop their medications every day, for a variety of reasons. Taking medications, as prescribed, is necessary to receive the advantages the medications offer (Al-Ganmi et al., 2016). These medications help reduce the symptoms of the disease, have protective qualities to help heart function, protect new stents, or control lethal arrhythmias. In the article Assessing the impact of medication adherence on long term cardiovascular outcomes by Bansilal et al., patient who had had an MI and were fully compliant with their medications, reduced their risk of recurrent cardiac events by 25 percent but only one half of the patients in the study were adherent to their medication two years out from their event (2016). The question is: why do patients stop their medications?

This writer has experienced a significant amount of patient medication issues in two of eight office locations and has determined the following:

1. Patients do not know their medications. They do not know what the medications are for, why they are on them, and why they should take them.
2. Patients do not bring accurate medication lists or bring their medication bottles with them when they see all of their health care providers.
3. The medication lists are not reconcilliated at the provider’s offices when consult notes are sent, when medications are changed, or when a patient leaves the hospital, especially when the patient receives care in a different health system.
4. The providers do not communicate when changes are made.

The Joint Commission designated medication reconciliation as a Nation Patient Safety Goal (NPSG) in 2004. This safety goal requires providers to obtain the necessary information to accurately and completely reconcile a patient’s medication, identify errors, and provide the patient with an accurate medication list, plus communicate this medication list to the patient’s other providers (Keogh et al., 2016). In the article from The Joint Commission Journal on Quality and Patient Safety, Keogh et al. discuss several barriers that exist for providers to ensure an accurate medication list. They are:

1. Patients are more complex with poly pharmacy
2. Multiple providers are prescribing medications
3. Patient self-reported medications are erroneous
4. Lack of communication between the primary care physician (PCP) and the specialist or lack of communication between specialists (2017)

Is it any wonder that patients do not take their medication or even know how to take their medications? It is this writer’s opinion that the lack of patient education and provider communication is a major problem and needs to be addressed to ensure patient safety and reduce possible adverse drug events in the ambulatory environment.

This writer has developed a PICOT question in an attempt to address these issues with nurse led education. The PICOT question is as follows:

 P: in adult patients discharged with new cardiovascular medications, 

I:  how does ambulatory medication education done at their first outpatient visit 

C: compared to not receiving medication education at the first outpatient visit

O: affect overall knowledge and medication compliance?

Understanding why patients do not take their medications is key. Patient education is an essential step to help patients understand the importance of their medications (deMelo Ghisi, Abdallah, Grace, Thomas, & Oh, 2014) and identifying barriers to medication adherence with strategic, personal interventions can increase patient knowledge and enable behavior changes (Xavier et al., 2016). 

A systematic review done by deMelo Ghisi, Abdallah, Grace, Thomas, and Oh (2014), cites that patient education is a necessary step to promote patient understanding and that patient education should be personalized to the patient and given by professionally trained staff. Nursing staff will need to be aware that extenuating patient circumstances will affect patient education and the education must be adjusted to the patient in order to be successful (deMelo Ghisi et al., 2014). The SPREAD trail in India showed that engaging and educating patients in post discharge medication and lifestyle education, while also identifying barriers and strategizing on how to overcome these barriers, led to a greater incidence of medication compliance (Xavier et al., 2016). 

Patient engagement is but one example of a patient safety strategy. Communication is critical in ambulatory safety and creating dialogue while educating patients on their medications, why they are used, and supplying patients with accurate medication lists with instructions can improve patient comprehension and compliance (Sarkar et al., 2017).

In conclusion, patient medication adherence leads to improved outcomes and a reduction in future CV events as well as a decrease in overall healthcare costs and utilization. Several of the studies cited in this paper show nurse led patient medication education increases medication compliance which reduces overall recurrent CV events in patients. When a patient has been educated on the reasons for their medications and understand the ramifications of stopping their medications, the nurse has empowered that patient to be their own health care advocate; which should lead to greater medication compliance, a reduction in medication errors, and improved communication amongst providers and their patients.

References

• Al-Ganmi A H Perry L Gholizadeh L Alotaibi A M 2016 Cardiovascular medication adherence among patients with cardiac diseae: a systmeatic review.Al-Ganmi, A. H., Perry, L., Gholizadeh, L., & Alotaibi, A. M. (2016). Cardiovascular medication adherence among patients with cardiac disease: a systematic review. Journal of Advanced Nursing, 72(12), 3001-3014.  201902051952221714766741
• Bansilal S Catellano J M Garrido E Wei H Freeman A Spettell CFuster V 2016 Assessing the Impact of medication adherence on long term cardiovascular outcomes.Bansilal, S., Catellano, J. M., Garrido, E., Wei, H., Freeman, A., Spettell, C.,…Fuster, V. (2016). Assessing the impact of medication adherence on long term cardiovascular outcomes. Journal of the American College of Cardiology, 68(8), 789-801.  20190216173032635268450
• deMelo Ghisi G Abdallah F Grace S Thomas S Oh P 2014 systematic Review of patient education in cardiac patients: Do they increase knowledge and promote health behavior change?deMelo Ghisi, G., Abdallah, F., Grace, S., Thomas, S., & Oh, P. (2014). A systematic Review of patient education in cardiac patients: Do they increase knowledge and promote health behavior change? Patient Education and Counseling, 95, 160-174.  20190216164345270000219
• Goss F Brachmann J Hamm C Haerer W Reifart N Levenson B 2017 High adherence to therapy and low cardiac mortality and morbidity in patients after acute coronary syndrome systematically managed by office based cardiologists in Germany: 1 year outcomes of the ProAcor study.Goss, F., Brachmann, J., Hamm, C., Haerer, W., Reifart, N., & Levenson, B. (2017). High adherence to therapy and low cardiac mortality and morbidity in patients after acute coronary syndrome systematically managed by office based cardiologists in Germany: 1 year outcomes of the ProAcor study. Vascular Health and Risk Management, 13, 127-137.  201902161601001365854860
• Keogh C Kachalia A Fiumara K Goulart D Coblyn J Desai S 2016 Ambulatory medication reconcilliation: Using a collaborative approach to process improvement at an academic medical center.Keogh, C., Kachalia, A., Fiumara, K., Goulart, D., Coblyn, J., & Desai, S. (2016). Ambulatory medication reconciliation: Using a collaborative approach to process improvement at an academic medical center. The Joint Commission Journal on Quality and Patient Safety, 42(4), 186-192.  201902161614581264357448
• Kourbelis J Franzon J Foote J Brown A Daniel M Coffee NClark R 2018 Effectiveness of discharge education on outcomes in acute coronary syndrome patients: A systematic review protocol.Kourbelis, J., Franzon, J., Foote, J., Brown, A., Daniel, M., Coffee, N.,…Clark, R. (2018). Effectiveness of discharge education on outcomes in acute coronary syndrome patients: A systematic review protocol. JBI Database of Systematic Reviews and Implementation Reports, 16(4), 817-824.  20190216173733189232349
• Sarkar U McDonald K Motala A Smith P Zipperer L Wachter RShekelle P 2017 Pragmatic insights on patient safety and intervention strategies in ambulatory settings.Sarkar, U., McDonald, K., Motala, A., Smith, P., Zipperer, L., Wachter, R.,…Shekelle, P. (2017). Pragmatic insights on patient safety and intervention strategies in ambulatory settings. The Joint Commission on Quality and Patient Safety, 43, 661-670.  201902161733551527353883
• Victor G Sommer J Khan F H 2016 21st century nurse’s role in decreasing the rising burden of cardiovascular disease.Victor, G., Sommer, J., & Khan, F. H. (2016). 21st century nurse’s role in decreasing the rising burden of cardiovascular disease. Anaesth, Pain, & Intensive Care, 20(4), 503-510.  20190216171618264454960
• Xavier D Gupta R Kamath D Sigomani A Devereaux P J George NYusef S 2016 Community health worker based intervention for adherence to drugs and lifestyle changes after acute coronary syndrome: A multicentre, open, and randomised controlled trial.Xavier, D., Gupta, R., Kamath, D., Sigomani, A., Devereaux, P. J., George, N.,…Yusef, S. (2016). Community health worker based intervention for adherence to drugs and lifestyle changes after acute coronary syndrome: A multicentre, open, and randomised controlled trial. Lancet Diabetes Endocrinology, 4, 244-253.  2019021616065076042652