Congress Abstracts 2006

36

SEATTLE CANCER CARE ALLIANCE (SCCA) DISCHARGE MEDICATION STUDY: AN EVIDENCE-BASED PROJECT. Terri Cunningham, RN, MSN, AOCN^®, and Mihkai Wickline, RN, MN, AOCN^®, Seattle Cancer Care Alliance, Seattle, WA; Bonnie Fryzlewicz, RN, MN, APON, Childrens Hospital and Regional Medical Center, Seattle, WA; Donna Berry, RN, PhD, AOCN^®, University of Washington School of Nursing/Seattle Cancer Care Alliance, Seattle, WA; and Carolina Sue Berg Bonham, RN, BSN, University of Washington Medical Center, Seattle, WA.

Complex healthcare systems are replete with opportunities for miscommunication, particularly with vulnerable patients who are compromised physically and emotionally during cancer therapy. Transition from the hospital to ambulatory care is a time in which accurate understandings are key for successful self-care, notably self-administration of medications.

The purpose of this study was to determine oncology and HSCT patients'/caregivers' understanding of discharge medication regimens following a hospital stay and to determine if the outpatient receiving nurse was aware of discharge medications. Two priorities in the 2005 ONS Research Agenda are directly relevant to this study: 1) research in nursing-sensitive patient outcomes and 2) translational research.

The Quality Health Outcomes Model guided our approach to this study. This model illustrates how aspects of the healthcare system mediate patient outcomes.

SCCA patients/caregivers who received chemotherapy as inpatients were offered participation as well as the ambulatory care nurses. Patients/caregivers were interviewed after discharge, inquiring as to knowledge (drug name, dose, frequency and purpose) and use of discharge medications. Then, the receiving ambulatory care nurse was interviewed. Percents of accurate medication knowledge and use and percents of receiving nurses' knowledge of discharge medications were calculated.

Fifty-three adults and 19 children were enrolled (40 general oncology and 32 HSCT patients) in the study. This abstract includes data from the adult patients and their receiving nurses. Of the 53 adults, 36 were interviewed post-discharge revealing multiple discrepancies between the prescribed discharge medications and what the patient was able to report about their discharge medications and that the written nursing discharge instructions often differed from the discharge prescriptions. In addition, there were differences in the receiving nurses' knowledge (N=34) about discharge medication depending on the service setting, HSCT nurses were aware of the medications in 20/22 patients, whereas nurses receiving general oncology patients were aware in 4/12 cases. Clearly, improvements are indicated in our patient education approach and system wide communication. Using these data as baseline, the research team will evaluate the findings and suggest mechanisms, processes or tools that will improve patient discharge medication understanding and communication with outpatient receiving nurses.