The Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) patient engagement survey impacts the bottom line of home health agencies substantially, by attracting referral sources and value-based reimbursement. It is imperative for organizations to understand the HHCAHPS survey, and work on improving each measure to maximize long-term growth and sustainability.
Assessing Medications - Question 5
Question 5 is one of seven questions included in the Home Health CAHPS survey Specific Care Issues domain, designed to assess how effectively healthcare providers discuss medicines, pain, and home safety with patients.
Specific Care Issues
This question evaluates the patient's perception of whether home health providers requested to see the patient's medications at the Start of Care. Optimizing performance on this question relies on an organization's ability to establish and implement effective medication reconciliation processes when initiating care and during transitional points throughout care.
Suggestions for Improving Specific Care Issues Related to Medications
- Ensure clinicians request to see all the patient's medications at Start of Care, Recertification, and Transfers (M2016), including over-the-counter and herbal medications.
- Reassess and discuss medications on each visit, and address any changes as needed. Homebound patients often take multiple medications and may need to be encouraged to provide additional medication they may be taking but forgot or neglected to reveal on prior visits.
- Implement teaching tools in staff training, and throughout medication reconciliation processes for structure and consistency.
In home healthcare, requesting to see the patient's medications is a significant step in reconciling medications, and HHCAHPS performance will reflect successful implementation of visual assessment. Several examples of tools and resources to ensure constructive medication assessment and reconciliation are outlined below:
MATCH: Medication Reconciliation Toolkit
Through support from the Agency for Healthcare Quality and Research (AHRQ), and collaboration between Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine and The Joint Commission, the Medications at Transitions and Clinical Handoffs (MATCH) Toolkit for Medication Reconciliation was developed to improve patient safety and decrease instances of patient harm related to medication discrepancies. The MATCH toolkit provides a collection of resources to guide healthcare organizations through developing and optimizing medication reconciliation processes.
Medication reconciliation is defined in the toolkit using several clinical steps, highlighted below:
- On admission, obtain a complete list of medications the patient is taking. This list should be obtained from the patient (through visual assessment of medications) whenever possible. Other resources (e.g., family/caregiver/past medical records) should be consulted only when necessary.
- Review this list with the patient to verify accuracy and completeness.
- Once admission orders are written, compare admission orders with the medication history list to check for any discrepancies. Confirm that any variations are intentional changes. If any unintended discrepancies are discovered, consult the physician and document resulting modifications.
- If the patient is discharged or transferred to another care setting, the discharge orders should be reviewed and compared to the patient's current medications list and reconciled to create the patient's discharge medication list. The patient should be educated on any changes, and the patient's discharge medication list must be communicated to the next provider of service to ensure continuity across the healthcare continuum.
Recommended resources from the MATCH toolkit:
- Talking Points: Justifying a Medication Reconciliation Project and Gaining Organizational Support (e.g., medication reconciliation as a patient safety issue, resource justification, and linking medication reconciliation with other initiatives, including CAHPS performance)
- Tips for Conducting a Patient Medication Interview
- Sample Letter to Leadership on Meetings Regarding Training and Implementation Strategy for Medication Reconciliation
- Sample Letter to Staff on Medication Reconciliation Educational Training Sessions
- Sample Staff Flier to Announce Rollout/Implementation of Medication Reconciliation Process
Check our blogs for the series on improving your agency's HHCAHPS scores by systematically reviewing each of the HHCAHPS questions and sharing opportunities for improvement.