Year of Publication

2016

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Debra Gay Anderson

Clinical Mentor

Ashley Baesler

Committee Member

Dr. Karen Stefaniak

Abstract

Purpose: The purpose of this evidenced-based education project was (i) assess current barriers and determining factors associated with medication adherence and how this coincides with health outcomes, (ii) assess whether medication adherence and hospital re-admission rates were improved with a comprehensive medication discharge educational plan.

Setting: The project took place on a 35 bed post interventional care unit (4IC) located in a 433 bed community care hospital in Central Kentucky.

Population: The population for this study was a sample of 10 acute myocardial infarction patients post percutaneous coronary intervention. Thirty percent of participants were female and 60% were male. Mean age was 63.6 years old (SD=10.5).

Inclusion Criteria: English speaking subjects who were post percutaneous coronary intervention and discharged on anti-platelet medication. Access to a phone for the 7 day post discharge phone call was a requirement for study participation.

Design and Methods: Data analysis was performed using SPSS® version 23.0 (SPSS Inc., Chicago, IL). Pre and post tests were scored and statistically analyzed to assess mean scores prior to, and following educational intervention. Data were analyzed using descriptive statistics. Paired T-tests were conducted to compare the differences in mean scores. This study considered values of p < 0.0001 significant for the analysis. Enrolled patients were seen on the morning of hospital discharge and the following activities occurred: A medication chart was given to patients that included anti-platelet medication name, dosage, indication, and frequency. The teach-back method was employed to assess patient understanding and retention. One week postdischarge patients were phoned to confirm discharge medications were filled as well as assessment of understanding and timing of anti-platelet medications via the teach-back method. Patients were reminded of their 30 day clinic appointment and the importance of attending this visit. Patients were seen at their 30 day standard of care clinic visit to assess adherence at 30 days.

Results and Conclusion: Participation in this project ultimately yielded a significant increase in anti-platelet medication knowledge from pre-test to post test. Baseline mean pre-test score of 1.30 (SD=.483); participants’ mean score significantly increased to 3.00 (SD=.000). There was no significant difference between 7 day and 30 day adherence rates and knowledge. Seven day mean pre-test score of 2.90 (.316) and mean post test score of 3.00 (SD=.000). 100% of study subjects were taking anti-platelet medications at 7 days and 90% of subjects were taking medications at 30 days. One study subject was seen in the emergency room within 30 days of index procedure with reports of shortness of breath and angina. A full cardiac workup concluded that the stent was patent and anti-platelet medication was changed. It was thought by the overseeing cardiology service that this subject was a poor responder to current therapy. It is unknown if this subject was adherent at 30 days because she did not attend the 30 day clinic visit.

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