Personal Reflection On The Cardiac Care IPL Activity

The activity that I performed and relates to this outcome is medication reconciliation. I performed this activity in my IPPE-III class as a PS-III student. It was a mandatory activity, which I carried out in workshop in the group of 4 students. In this activity, we were given a patient case, which had list of all the medications that patient was taking and had patient’s demographic information. After reviewing patient’s given information, I had to interview a standardized patient and find out if the patient is taking all the medications as directed by prescriber or not. If patient is taking any other vitamins, herbal or OTC medications that is not on the list and also had to look out for if there is any discrepancy with the medications patient currently on for example, duplicate therapy, drug-drug interaction, incorrect frequency etc.

Health Teaching will cover the administer medication as prescribed. Explain symptoms and interventions for decreased cardiac output related to etiological factors. Explain drug regimen, purpose, dose, and side effects. Explain progressive activity schedule and signs of overexertion. Explain diet restrictions (fluid, sodium). Follow up with Dr Farhoud, cardiologist as direct or needed.

First goal: Patient will verbalize understanding of the importance of follow her heart medication regime as doctor prescribed it and describe the possible consequence of a non-compliance with her treatment by the end of her today’s appointment.

If an individual expresses that they want to discontinue their medication and becomes non-compliant with their medication then it is my role to identify the risk they are currently posing and update their risk assessment; inform their CMHT and let the citizen know of the consequences to them not taking their medication and reiterate that it is their choice, as long as they have all the information to make a decision (wise or unwise). It is important to emphasise that not all individuals understand information the same way, therefore I have found that the use of internet, booklets, music, audio recordings, talking group therapy and pictures can be applied to explain a situation to a resident if they are unsure of particular consequences to their health.

Other situations that could arise could be around a young adult not wanting to take their medication but not understanding the importance of the medication and the consequences of not taking it, if it is for something like epilepsy or depression.

Some of the factors that patients do not adhere to when their healthcare provider tells them too is due to patients being too busy. Often times life is very busy as we all know this but forgetting to take of yourself can have detrimental effects to your health. Some people think they can get better on their own without the help of a doctor so they feel like they will be fine or able to handle any health complication on their own. Another reason is that often people do not understand or they forget what the doctor is telling them about their prescribed treatment regimens and other patients decide to simply not follow it. As stated in the article by Sklar, Min Sen Oh & & Chuen Li, 2008 “Poor communication with healthcare providers was also likely to cause a negative effect on patient’s compliance (Bartlett et al 1984; Apter et al 1998)”. Miscommunication between a doctor and patient is at the root of most adherence problems. Often times patients leave their doctors office not knowing or having the slightest clue to what they should be doing. Instead of asking for help or clarity they just leave. Communication needs to be clear and effective for both the patient and the doctor. Non-adherence is wide spread when it comes to patients not adhering to what professionals tell them. Many patients will have significant risks because they forget,

“The odds of having good health outcomes are 2.88 % higher when patients are adherent” ( DiMatteo, Haskard-Zolnierek & Martin, 2012, p. 75). Nonadherence occurs for many reasons and may or may not be intentional. Nonadherence is defined as the failure to follow prescribed medical advice. Examples of actions considered to be medical advice are: to take medication as prescribed, make behavioral changes such as diet and exercise, keep appointments, and have screenings/testing done. Nonadherence, also called noncompliance also causes frustration of providers and patients, and wastes resources. Rates of nonadherence can be as high as 70% with complex regimens (Martin, Williams & DiMatteo, 2005). Factors in compliance with medical advice include: severity of disease, complexity of regimen, patient knowledge and beliefs, costs incurred by the patient, resource availability, availability of social support, psychological problems, and rapport and communication with healthcare providers.

Collecting a sufficient pool of data, specific to the patient population and intervention I hope to examine, has been exceedingly challenging. Although there is abundant data regarding medication compliance and interventions to improve adherence to medication regimens, I have found that many of these studies are related to specific disease processes such as HIV, diabetes and cancer. However, despite initially being discouraged by the lack of data existing my proposed research, I have taken this barrier in stride as it demonstrates the need for further

Non-adherence has adverse implications in regards to a variety of clinical conditions. Cardiovascular disease is a serious healthcare issue and accounts for approximately 1 million deaths annually in the United States. In addition, approximately 5.7 million people in the United States suffer from some form of cardiovascular disease. According to Iuga & McGuire (2010), non-adherence among patients with cardiovascular disease stands at about 50% and causes adverse progression in the intensity of cardiovascular-related complications. Non-adherence among patients with cardiovascular disease is the leading cause of death. Medication is the primary form of treatment for patients with cardiovascular diseases.

This article, written by healthcare professionals in the greater Philadelphia area, describes the methodology and findings of the early phase of a long-term study to determine the best ways to improve medicine taking compliance. A total of 132 subjects were selected through random sampling procedures from regular hypertension programs at The Hospital of the University of Pennsylvania in Philadelphia, PA. Patients were interviewed and filled out a questionnaire regarding how often they took their blood pressure medication. The results showed a positive relationship between blood pressure control and compliance, especially when compliance was differentiated between those who missed the occasional pill and those who missed three or more. The article notes that it is important to realize that, because the study relied on patients to accurately detail their behavior, some of the information must be taken with a grain of salt. Three variables were also found to contribute to explaining self-reported medication taking compliance. These were control over health matters, perceived barriers, and duration of treatment.

Medication-noncompliance problems are common among elderly patients who are discharged from the hospital and are using several drugs for their chronic diseases (Ahmad et al., 2010). Medication management is a challenge for adults of all ages, but for the elderly, physical limitations, such as vision problems, memory loss, arthropathy) can make it particularly challenging to take medicine according to a set schedule(Simonson, 1984). In Australia, the population is ageing rapidly. Since 1970, the Australian population has aged significantly increase in the proportion of adults aged 85 years and older(Hillen et al., 2015). The prevalence of multiple chronic conditions in the older population is reported to be between 65% to 80%.(Hillen

Nursing literature strengthens the medical view that non-compliance is a large problem that often comes with damaging consequences, often related to cost, re-hospitalization and relapses that might have otherwise been prevented (Russel, Daly, Hughes, & Hoog, 2003). Research indicates that a patient who is not satisfied will rarely comply with directions and often does not show up for return visits and this gives meaning as to why this is such an important topic. A show of statistics indicate that non-adherence to medications causes 125,000 deaths yearly and can be accounted for 10% to 25% of reported nursing home and hospital admissions in the United States alone (Atreja, Bellam, & Levy, 2002).

The provision of written medication information given to the patient helps significantly in cases of medication non compliance (McGraw & Drennan 2004). This is because it aids in memory retention and presents patients with access to a reliable source of concise medication information, particularly if the patient needs to be reminded of certain aspects (Gorgos 2006). These written medication information sheets need to be provided in the patients primary, dominant language because it reduces the difficulty and limits barriers to patient understanding (Gorgos 2006).This is important because this intervention aims to increase a patient’s understanding of their medications, and when a patient feels more competent with the use of their medications, reduced

Medication compliance is extremely critical for complete recovery. The importance of medication compliance manifests in the consequences of noncompliance. The main consequence of noncompliance is treatment failure (4). This will ultimately result in more pain and hospitalization. Another consequence for noncompliance is toxicity. Toxicity results when patients increase the dose without prescription. Drug interaction is another consequence which occur when patients use two or more drugs without following the physicians

Non-compliance is expressed as the failure or refusal to comply. In this instance, it is used to reference a “patient who elicits through their behavior— the inability of taking medication, following a diet, executing lifestyle changes—or not corresponding with agreed recommendations from a health care provider” (McIntyre, 2016). Non-compliant behavior is actually believed to be an epidemic and is likely one of the most common causes of treatment failure for chronic conditions as it hinders the doctor’s ability to provide optimal care” (McIntyre, 2016). Patient education can