Discharge Medication Counseling: Knowledge Is Power

The Nascimentos, who speak Portuguese and traveled to Philadelphia so 11-year-old Stephany could be treated at CHOP’s Cancer Center, benefitted from extra instructions from a pharmacist and medical interpreter. It’s understandable that parents can feel overwhelmed when they are responsible for giving their child 10 or more daily medications after they’ve been discharged from the Hospital.

And if the parents’ first language is not English, the stress and potential confusion are multiplied. Confusion can lead to missing doses that the child needs to get well or, even worse, result in dangerous medication errors.

Krisha Palma, PharmD, leads the Discharge Medication Counseling Program, Children’s Hospital of Philadelphia’s initiative to bring clarity and competency to families whose children need multiple medications after being discharged.

Now, when family members will be required to give their child multiple medications at home, Palma or another pharmacist meets with them on the day of discharge. For non-English speakers, a professional medical interpreter is also present.

For each medication, Palma reviews the name, what it looks like, storage requirements (some need refrigeration), dose, administration (pill, liquid, injection), timing (once a day or more) and other requirements (given with food or before bedtime). She also explains how a pill box and medication calendar or chart can help the parent keep everything straight.

'Teach-back'

Then she has the parents explain everything to her, using the teach-back method to ensure they truly understand it all.

“It’s the last double check before they’re ready to go home,” Palma says.

The program was piloted initially with Cancer Center families that needed an interpreter, and were at high risk for noncompliance or medication errors once they were discharged.

“In Oncology, most of the patients had been healthy before their cancer diagnosis,” Palma says. “Many families are inexperienced with giving medication beyond a short dose of antibiotics. Often, oncology patients go home on oral chemotherapy and a lot of other meds to treat side effects, like antibiotics, insulin, blood pressure medicine and anti-nausea meds.”

In addition to the basics, counseling includes tricks on how to give medications to children who may be reluctant to take them, Palma says. “We go over tips to help with adherence, like using alarms as reminders.”

Education raises adherence

Surveys Foreign Language Translations 41,500in-person encounters60,500telephonic encounters 80 languages interpreted Fiscal year 2016 show that extra counseling is well received by patients and families, who say they feel very comfortable giving medications afterward. Clinicians also report a higher level of adherence to medication regimens.

Before joining the counseling program, pharmacists take special training that emphasizes family-centered care and how to work most effectively with an interpreter.

“When the parents are confident about how to give the medications, it gives them a sense of control in what is usually a situation where they feel out of control,” Palma says. “They leave the Hospital thinking, ‘We can do this.’ And — with that little extra coaching — they can.”