Improving One HHCAHPS Question at a Time

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Karen Utterback By Karen Utterback 
Former Vice President, Product Marketing and Strategy, McKesson (Retired)
A nurse reviews medications with her patient in accordance to HHCAHPS standards

Carroll Home Care in Maryland has taken deliberate steps to improve its score on the Home Health Care CAHPS Survey, and the results can be clearly seen.

The agency ranks two percentage points above the national average (83%) on the question about whether the home health team discussed medications, pain and home safety, which is one of the questions the agency focuses on.

Diane Link, RN, BHA, executive director, says that all clinicians and staff have a list of the HHCAHPS questions and a particular procedure to follow to make sure patients and family understand what’s being discussed at each step. “It’s scripting,” Link says of the protocols the agency has developed, “but we don’t call it that.”

The above question has three parts, and each is stressed on every visit. Verbalization is critical so the patient and family members understand what services are being performed.

A home safety assessment is performed on the first visit, with patient and family member participation. Written information on home safety and recommendations to improve safety are reviewed and then left at the home. Safety aspects are reviewed throughout the care episode and reinforced upon discharge.

Likewise, medications are addressed at every visit, starting with a medication reconciliation. Patients are instructed on the benefits of using a single pharmacy as an additional safeguard against possible drug/drug interactions. Staff create a written list of medications that is left in the home, along with literature on each. The list is verbally reviewed and updated at each visit. The agency provides pill boxes as needed and a notepad with the agency logo on it for the patient or family members to write questions for the physician. Medications are reviewed a final time upon discharge.

“We use words like ‘side effects’ and not ‘adverse reactions’ when discussing medications,” says Link, mirroring the language used in the HHCAHPS Survey.

A pain assessment is performed on each visit, using visual pain expression charts and/or number ratings. Pain management goals are discussed using prescription and non-prescription pain relief measures. Clinicians work with a patient’s physician to offer pre-medication for painful procedures and follow up with the patient 24 hours after a pain medication changes. When a patient reports a pain issue not alleviated by current medications, the clinician calls the physician before leaving the home.

None of these procedures is ground-breaking, but, when taken together, they help reinforce to the patient and family members that the home health staff is taking an active role in the patient’s care. How do your scores compare to Carroll Home Health, and where can you do a better job?

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