Medicare will soon release new rules requiring hospitals to focus more attention on patients after they are discharged. Readmissions have cost Medicare $26 billion a decade and the program plans to cut payments to hospitals that have high readmission rates. Nonadherence to medication regimens may be one factor in high readmission rates. After leaving the hospital, patients are not always likely or able to adhere to the medication regimens they were prescribed, sometimes with disastrous results. Without supervision from a health care provider, some patients either never take the prescribed medication, or take the wrong dosage. One study found that more than seven in ten (72 percent) of adverse events after a patient left the hospital were related to medication.
A new study, conducted by an interdisciplinary research team based at The Johns Hopkins Hospital including two nurses and a pharmacist, and funded by the Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative (INQRI), indicates that the solution may lie with having a registered nurse oversee medication management during that transitional period. The study is in the current issue of the Journal of Nursing Quality Care.
“It can be days, weeks or even months before a patient sees his or her primary care provider after leaving the hospital,” said Linda L. Costa, Ph.D., R.N., N.E.A.-B.C., nurse researcher at The Johns Hopkins Hospital and assistant professor at Johns Hopkins University School of Nursing. “Very often, during that time, no one is checking to be sure that the patient is taking the right doses of the medication at the right times, or even that the patient is taking medication at all. And even if they meet sooner with their primary care providers, there’s not always a guarantee that the provider will have access to the hospital records for that patient in a timely fashion. Having a nurse coordinate care during this period can literally make the difference between remaining at home or going to the emergency room in some cases.”
“We are continuing to look at the Institute of Medicine report and its associated recommendations at the Health Resources and Services Administration… The administration… recognizes and understands the challenges that we face in meeting what is a growing demand for health care services across the United States. That growing demand is the result of a lot of different factors, including the aging of the population as well as the increasing size of the U.S. population… In many ways part of the solution to those challenges, as well as other challenges, have nursing at [their] core.”
—Mary Wakefield, R.N., Ph.D., F.A.A.N., administrator, Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services, at the Nurse.com first “National Day of Dialogue,” June 29, 2011
“Health care reform has opened the door, but we need you [nurses] to show patients the way through… There’s no one I'd like to talk to more than you… It won’t be easy, but you didn’t listen when critics said you couldn't run your own clinics...”
—U.S. Secretary of Health and Human Services Kathleen Sebelius, HHS secretary Sebelius Addresses Nurse Practitioners in Las Vegas, Las Vegas Review-Journal, June 23, 2011
