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Date of Award
Restricted Evidence-Based Project Report
Doctor of Nursing Practice (DNP)
Carole A. Pepa
Adverse events related to medication discrepancies are a recognized risk for readmission within the 30 days after transition from hospital to home. Although successful in resolving medication discrepancies, traditional Medication Therapy Management (MTM) services have not demonstrated a reduction in readmissions. This evidence-based practice project sought to answer the PICOT question: In Medicare patients aged 65 years and older who are discharged from the hospital, what is the effect of the Nurse Practitioner (NP) in the role of Medication Therapy Management provider compared with conventional practice during the four weeks post-hospital discharge? Kotter’s 8-Step Change Model and the Modeling Role Modeling nursing theory framed implementation of this project at a Midwestern community hospital. Best practice interventions were adapted from the evidence-based “Reducing Adverse Drug Events” guideline (Zwicker & Fulmer, 2008). Thirty-three patients were eligible for participation, with 14 accepting a home visit from the NP. Outcomes of interest included readmission rates, medication discrepancies, additional issues within the scope of practice of the NP, and patient acceptance of the NP in the MTM role. Participants experienced both a lower rate of readmissions (21% versus 26%) and fewer readmissions directly related to the original admission than non-participants. Eight of the fourteen participants (62%) experienced medication discrepancies. Five participants (36%) experienced other health care needs amenable to NP care. Participants also demonstrated acceptance of the NP in the Medication Therapy Management role as evidenced by acceptance of NP recommendations for medication discrepancy resolution (100%), acceptance of NP recommendations for additional needs identified within the NP scope of practice (80%), and recommendations by the participants to continue the project for other patients (79%). Findings from this project support continued development of the NP as MTM provider in transitional care.
Fischer, Rachel I., "The Nurse Practitioner as Medication Therapy Management Provider: Effect on Patient Outcomes Post-Hospital Discharge" (2012). Evidence-Based Practice Project Reports. 36.