I disseminated the research findings on the education program to the staff members through a PowerPoint presentation. The final findings and recommendations following analysis were presented to the site’s administrator in the form of a project summary. I added the suggestions provided by the audience during the presentation to the final DNP product, which was accepted for additional dissemination by the nurse leader. The administrator decided that plans should be made to allow me to report my findings to other staff members during continuous education sessions. The final staff education program, alongside the MDT tool, will also be printed out and made accessible to staff members at the site.
Additional audiences that would benefit from the findings of this project are pharmacists, who are instrumental in the administration of drugs to patients. These findings will also benefit other medical providers in other practice sites as well as the entire medical community, given the gravity of negative polypharmacy among elderly patients. Therefore, the administrator advised me to prepare a brief oral presentation or poster presentation for an upcoming nurses’ and physicians’ conference to be held in September 2018. I also intend to develop my findings into a manuscript to be considered for publication in a peer-reviewed journal.
Analysis of Self
I have undergone growth in various aspects of my life during the last 3 years as a DNP student. These aspects include spiritual, intellectual, and professional growth. I
started looking into the practice problem of polypharmacy among elderly patients in the initial stages of my DNP program. Most of my practicum hours were spent studying the practical aspects of polypharmacy, which has led to an understanding of the challenges faced by elderly patients suffering from multiple comorbidities. I have also explored the literature on polypharmacy among geriatric patients and strategies for mitigating the negative effects of polypharmacy. As a result, I have enhanced my knowledge, dexterity, and capacity to cause a change in geriatric nursing with respect to polypharmacy.
My responsibilities as an adult-gerontology nurse practitioner involve conducting autonomous health assessments, physical examination, and patient education to many adult patients. I also engage in quality improvement pursuits. Exploring the impact of staff education on the confidence of medication reconciliation through this DNP project has given me a chance to execute quality assurance modifications that are backed by evidence in the literature. For example, I explored the use of an evidence-based staff education program to increase the confidence of medication reconciliation to avoid the negative effects of polypharmacy among elderly patients. This intervention is in line with the AACN (2006) Essential III of clinical scholarship and analytical methods for
evidence-based practice. This DNP project has also provided a basis for the next phase of my career as a nurse leader by providing an opportunity to lead change.
Project Completion
The main challenge of this DNP project was the inability to implement the role play, self-study, and experiential aspects of the program. As a result, only the didactic aspect of the chosen program was implemented due to time constraints at the practice
site. Future scholars could consider dedicating adequate time to conduct all of the
proposed education modalities. The completion of this project provided me with a useful insight that as much as patient involvement in their health (through medication
compliance) affects the overall health outcomes, health care providers have a role to play by simplifying the medication regimen and reducing the pill burden. Health care staff require sufficient training, knowledge, and evidence-based strategies to handle patients’ medication and to promote better health outcomes. This project emphasizes the need for staff education in conducting medication reconciliation in a primary care setting.
Summary
Polypharmacy, which is the use of five or more drugs simultaneously, is a common practice among elderly patients suffering from multiple comorbidities.
Polypharmacy is associated with negative effects, such as adverse drug events, increased medical costs, and medication noncompliance. Sometimes patients receive unnecessary medications that do not do much to improve their conditions. Medication reconciliation is an evidence-based strategy of ensuring that patients take only the required medications whose safety and efficiency is assured. Medication reconciliation is best done at the health facility before discharging patients. However, the benefits of medication reconciliation are yet to be realized in my practice site due to low confidence about executing the process. The purpose of this project was to develop an evidence-based staff development program to improve staff confidence in medication reconciliation and potentially reduce the risk of polypharmacy at the practicum site. An evidence-based staff education program was used as the mode of education. Pretest and posttest surveys were
conducted before and after administration of the education program. There was a significant increase in staff confidence of medication reconciliation after the
administration of the program. I found clinical practices should strive to educate their staff members about the correct way of performing medication reconciliation. I am hopeful that executing the recommendations indicated in this project will bring positive change by reducing the negative effects associated with polypharmacy and improve the wellbeing of geriatric patients.
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Appendices
Appendix C: Invitation to Participate in a Staff Education Program on Medication Reconciliation
Dear Study Participant,
This is an invitation to all willing staff members at the clinic to participate in a staff education program on medication reconciliation and reducing the negative impacts associated with polypharmacy. Your participation will contribute to gaining better understanding of the provision of quality care during transitions, conducting medication reconciliation, and reducing the adverse effects of polypharmacy. It is expected that the findings of this study will improve the health of geriatric patients receiving care at the clinic. A summary of the results of this research will made available to you upon request after the completion and approval of the study.
The proposed training will take place on 12th February, 2018 at 10 am at the clinic’s conference hall. The education program is expected to take a maximum of 45 minutes and will include a pretest questionnaire (10 questions), a 20 minute presentation that will be followed by a brief question and answer session, and a posttest questionnaire. Please confirm your willingness to participate in the study.
Thank you for your participation!
Sincerely,
Lawrence James-Osondu
Appendix D: User Survey Questionnaire on Conducting Medication Reconciliation to Prevent the Effects of Negative Polypharmacy
Table 2
Staff Confidence in the Pretest and Posttest Survey
Question Pretest mean (SD) N=10 Posttest mean (SD) N=10 1. How well can you identify important barriers an elderly patient
faces helping to update medication lists during office visits?
2.3 (0.67) 4.3 (0.67)
2. How confident are you that your questions can elicit the right atmosphere for the patient to give you all the necessary information needed for medication reconciliation?
2.1 (0.57) 4.4 (0.70)
3. How effectively can you complete an evaluation of a patient’s medication safety at home?
2.5 (0.85) 4.4 (0.52)
4. How confident are you in your ability to complete an evaluation of a patient’s functional abilities at home?
1.8 (0.92) 4.3 (0.67)
5. How adequately can you communicate with a patient’s follow- up provider about the important
issues managed in the in-patient stay?
6. How confident are you in your ability to adequately
communicate with a patient’s follow-up provider about the important issues requiring follow-up after hospital discharge?
2.1 (0.74) 4.1 (0.74)
7. How confident are you in your ability to identify the appropriate discharge setting for a patient?
2.1 (0.57) 4.5 (0.53)
8. How confident are you in your ability to interact with other healthcare practitioners to execute medication reconciliation?
2.1 (0.99) 4.5 (0.71)
9. How confident are you in your competence to obtain a comprehensive medication list from patients?
2.4 (0.70) 4.4 (0.70)
10. How confident are you in your ability to complete a medication reconciliation with a patient?
Appendix E: Staff Education Program Didactics
Introductory didactics provide staff members with foundational knowledge on: The risks of care transitions
• Poor management of patient risks
• Duplication of drugs
• High incidence of hospital readmissions
Challenges faced by elderly patients on polypharmacy
• Large pill burden
• Drug administration
• Drug interactions and side effects
• Adverse drug events
Specific interventions to reduce these risks and challenges.
The teachings are based on Coleman’s model that which focuses on four key elements of successful care transitions:
(1) Medication self-management and reconciliation, (2) Patient activation for self-care,
(3) Timely follow-up, and
(4) A list of “red flags” and what to do when they occur.