What important teaching points should be reinforced for a client taking lisinopril?

Is there anything more challenging than teaching a patient about their medications?

Lets be honest, the volume of information about any one medication includes indications, multiple contraindications, multiple interactions, warnings, precautions, side effects, adverse reactions...and then there are the directions for administration.

And patients can have 20...30...40 or more medications!  To further complicate matters, the patient may have literacy or cognition deficits.

Prioritizing your approach to medication teaching, using the following steps, will help you and your patient/caregiver achieve success!

1. Determine which medications require teaching.

The patient/caregiver probably already knows the schedule, purpose, and notable adverse reactions for some of the medications they are taking.  If /she does not know these three (3) points for any medication, teaching is indicated.

On admission, ask for recall from the patient/caregiver of the purpose and schedule for each medication.

At a minimum the patient/caregiver should know - 

• when and how to take the medication,
• the reason for the medication
• notable adverse reactions that require physician notification
  

EXAMPLE: The patient is on 10 (ten) different medications.  The patient OR caregiver can recall the schedule and purpose of seven (7) of the medications. Therefore three (3) of the medications require teaching/recall.

2. Limit teaching to 1) purpose, 2) notable adverse reactions and 3) schedule of administration.

You are already providing written medication information.

You are already providing medication information as part of your compliance with the Medicare Conditions of Participation (CoP) Standard §484.60(e)(2), Tag G161. The written information provides the list of indications,  contraindications, interactions, warnings, precautions, side effects and adverse reactions for each medication the patient is taking.

It's unrealistic to expect a patient/caregiver to remember and recall all information about a medication.

Limit the teaching to the purpose of the medication, adverse reactions that warrant a call to the doctor, and the schedule of taking the medication.

For example, if teaching is required for Lisinopril, the patient/caregiver should recall the following:

1. the medication is for high blood pressure,
2. the medication is taken by mouth, once a day, with or without food,
3. light-headedness and dizziness are notable side-effects,
4. where to find all adverse reactions, warnings, contraindications in the medication information sheet provided.

3. Use the 'Teachback' method for effective patient recall of medication teaching.

Principles of 'Teachback"...according to Agency for Healthcare Research and Quality (AHRQ)

• Teachback is a test of how well you explained the concept. Teachback is NOT a test of the patient's knowledge.
  
• Decide how you will ask for recall. An example of asking for recall: 
  • "We covered a lot today and I want to make sure that I explained things clearly. So let's review what we discussed. Can you please describe the 3 things you agreed to do to help you control your diabetes?"
    
• "Chunk and Check."
  • Teach one concept, then ask for recall. Don't wait until the end of the visit to initiate teach-back. Chunk out information into small segments and have your patient teach it back. Repeat several times during a visit.
    
• Clarify and check again. If teach-back uncovers a misunderstanding, explain things again using a different approach.
  • Ask patients to teach-back again until they are able to correctly describe the information in their own words. If they parrot your words back to you, they may not have understood.
    
• Use the show-me method.
  • When prescribing new medicines or changing a dose, research shows that even when patients correctly say when and how much medicine they'll take, many will make mistakes when asked to demonstrate the dose. You could say, for example:
    • "I've noticed that many people have trouble remembering how to take their blood thinner. Can you show me how you are going to take it?"
• You can allow patients to refer to handouts when using teach-back, but make sure they use their own words and are not reading the material back verbatim. 
  
  • Use the medication information sheet along with teach-back. Write down key information to help patients remember instructions at home. Point out important information by reviewing written materials to reinforce your patients' understanding.

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Tags: OASIS M2020 Medications

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