Pulse
Drug Test
A pilot program at Regions Hospital tests heart failure patients’ ability to set up their meds.
By Kim Kiser
Mike Cannon’s inspiration for creating a “medication boot camp” at Regions Hospital in St. Paul, where he is director of nursing for cardiovascular services, didn’t come from the military. It came from his own parents’ experience.
After a hospitalization for peripheral vascular disease, his father, who has since passed away, was sent home with about a dozen medications. Both the hospital staff and the family were convinced that Cannon’s mother would be able to make sure her husband was taking them properly. “They appeared to me and the hospital staff to be pretty sharp; but what I found out pretty quickly was that they could not and did not set up their meds correctly at home,” he says. “I thought, ‘There’s two people I know were fooling the system. I’ll bet there are more out there.’”
With that in mind, Cannon came up with a plan to test whether patients with congestive heart failure who are being discharged from Regions understand their medication instructions. “It’s not uncommon to send them home on 20 or more medications,” he says. And not taking their medications or taking them incorrectly can cause problems that can land them back in the hospital—a situation all hospitals are trying to prevent.
In a pilot that began in September of 2010, patients with heart failure who were going home, rather than to a nursing home, met with a pharmacy technician the day before discharge. The tech gave them a seven-day four-times-a-day pill container along with several medication bottles, each of which contained a different-colored bead. The tech asked the patient (or the caregiver who would be setting up the meds) to follow the directions on the medication orders and place the correct bead in the correct hole in the pillbox. The person would have 15 minutes to complete the task. One mistake was considered failure.
Of the first 50 patients who were tested, 43 (86 percent) passed. Those who did not were referred to home health care, so a nurse could come in once a week to set up their medications. More important, the readmission rate for patients who went through boot camp was 14.6 percent; the rate for those who did not was 24 percent. After adjusting some parts of the process, Regions recently reinstituted the program.
Cannon says they plan to continue testing medication boot camp in hope of one day taking it beyond his department. “There are more people with heart failure in this country than any other diagnosis,” he says. “It’s a large population, and if you can make an impact on them, you can make a bigger impact on the whole issue of readmissions and general care.”