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O4: Using principles of continuous improvement to impact Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores through pharmacy-driven interventions
Intermountain Healthcare’s operating model is one of continuous improvement. This model was used to identify barriers and develop pharmacy-driven interventions to improve the communication about medicines domain scores within the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. This survey offers objective and meaningful information that is important for consumers and creates incentives for hospitals to improve quality of care. This study took place at Riverton Hospital, a 97-bed community hospital that is part of the Intermountain Healthcare system in Utah.
We reported scores from the surveys between January 1, 2020 and September 30, 2020. Our primary measure was the improvement of the communication about medicines domain, which is composed of two subgroups relating to indications and side effects. Our secondary measure was the impact on the overall likelihood to recommend for the hospital.
Interviews were conducted with pharmacy staff to identify barriers to improving the medication domain. Barriers identified were: inconsistent presence of pharmacists in patient care areas, insufficient time to complete all discharge teachings, lack of emphasis on side effects, and the absence of a standardized process for collecting patient medication histories. Interventions were created one at a time to address these barriers. Interventions included: increasing pharmacists’ presence in patient care areas; changing intern hours to provide more coverage for completing discharge teaching; emphasizing side effects; and creating a standardized process and script for collecting medication histories. These barriers and experiments were tracked on a Kata chart and discussed during daily department huddles.
Increasing pharmacist presence in patient care areas resulted in better collaboration with providers. Pharmacists were available to provide information about medications, make interventions, and were approached often with drug information questions. Some pharmacists reported more distractions while performing clinical duties.
Creating a standardized process for medication histories resulted in better patient care by mimicking home regimens with inpatient regimens whenever possible. It helped limit drug-drug interactions and captured useful information for discharge teaching. This change also resulted with more consistent data entered in patients’ electronic medical records (EMR) from pharmacy staff.
The change to intern schedules allowed for a pass-off from the afternoon pharmacist to the pharmacy interns, which helped to determine priorities for discharge teaching. The adjusted schedule provided an additional thirty minutes for more teachings to be completed by pharmacy interns.
The score for the medication domain decreased from 73.97% (n=108) to 65.22% (n=95) from January 1, 2020 to September 30, 2020, respectively. The subgroups also showed a decrease in scores: the indication subgroup changed from 88.89% (n=108) to 80.43% (n=92), while the side effect subgroup changed from 59.05% (n=105) to 50.00% (n=94). The score for the hospital’s likelihood to recommend increased from 84.68% (n=222) to 94.35% (n=177).
It is difficult to determine whether our interventions correlated with decreased HCAHPS score. The decrease may be attributed to less surveys compared to baseline scores; interventions began in July; some pharmacy staff did not participate; pharmacists do not interact with every patient; and the inability to communicate face-to-face with many patients due to isolation procedures during COVID-19 pandemic. Although the medication domain score is associated with pharmacy’s role in patient care, it is highly influenced by nursing and physician interventions. Greater impact on HCAHPs scores could be seen by implementing multidisciplinary continuous improvement projects. Further research and collaboration is needed.