Digital Repository Masters Projects Spring 2025 Structured Medication Management Visits: A Tool for Home Health Nurses Kristin Allen Weber State University Follow this and additional works at: https://dc.weber.edu/collection/ATDSON Allen, K. 2025. Structured Medication Management Visits: A Tool for Home Health Nurses Weber State University Masters Projects. https://dc.weber.edu/collection/ATDSON This Project is brought to you for free and open access by the Weber State University Archives Digital Repository. For more information, please contact scua@weber.edu. WSU REPOSITORY MSN/DNP Structured Medication Management Visits: A Tool for Home Health Nurses Project Title by Kristin Allen Student’s Name A project submitted in partial fulfillment of the requirements for the degree of MASTERS OF NURSING Annie Taylor Dee School of Nursing Dumke College of Health Professions WEBER STATE UNIVERSITY Ogden, UT April 25, 2025 Date Kristin Allen BSN, RN, MSN Student April 25, 2025 Student Name, Credentials (electronic signature) Date JoAnn Tolman, DNP-L, MSN-Ed, RN, CNE April 25, 2025 MSN Project Faculty Date (electronic signature) Anne Kendrick, DNP, RN, CNE (electronic signature) DNP, N, CNE MSN Program Director Note: The program director must submit this form and paper. April 25, 2025 Date 1 Structured Medication Management Visits: A Tool for Home Health Nurses Kristin Allen, BSN, RN, MSN Student Annie Taylor Dee School of Nursing Weber State University MSN Project 2 Abstract Purposes/Aims: Transitions from hospital to home pose a high risk for medication errors, leading to preventable harm and hospital readmissions. This project aims to develop and implement a structured medication management visit tool for home health nurses to improve their confidence and satisfaction with performing a medication management visit, thereby supporting safe care transitions. Rationale/Background: Home health nurses play a critical role in medication management, but a lack of structured guidance leads to inconsistencies in reconciliation and education. A standardized tool provides clear protocols for medication review, patient teaching, and caregiver engagement, ensuring continuity of care and fostering interdisciplinary collaboration. Methods: Guided by the Johns Hopkins Nursing Evidence-Based Practice Model, this project includes a pre-survey to assess nurses’ baseline confidence and satisfaction, structured educational sessions on using the tool, and a post-survey to evaluate its effectiveness. The tool standardizes medication reconciliation, side effect education, caregiver involvement, and adherence monitoring. After 2 months, data analysis will assess nurses’ confidence and satisfaction with using the medication management visit tool. Results: Using a structured medication management visit tool increased home health nurse confidence and satisfaction, improved efficiency, and enhanced interdisciplinary collaboration. The structured approach supports continuity of care and aligns with home health regulatory standards. Conclusion: Implementing a structured medication management tool streamlines processes, enhances nurse confidence and satisfaction, and reduces variability in patient education. Effective medication education can support a safe transition from hospital to home. To 3 encourage broader adoption, findings will be shared with home health nursing leadership, organizations, and conferences. Keywords: medication management, home health nursing, care transitions 4 Structured Medication Management Visits: A Tool for Home Health Nurses Transitions in care, particularly from hospital to home, have been identified as a time when medication errors frequently occur in elderly patients (Alqenae et al., 2020). Medication errors are listed as one of the leading causes of hospitalizations and avoidable harm in healthcare systems globally (World Health Organization, 2024). Within the United States, Medicare covers medication management teaching visits for Medicare patients who need help understanding and using new medications (Centers for Medicare & Medicaid Services, 2023). Medication management teaching visits can be instrumental in preventing medication harm (Mardani et al., 2020). Many primary care providers are ordering medication management visits through a home health agency for patients transitioning from an acute care facility to self-care at home (The Joint Commission, 2022). Home health nurses are in a position to educate patients about the appropriate use of medications, side effects, and interactions. However, there is a lack of guidance and structure for medication management visits, and the nurse must determine what to accomplish during the visit and how to provide the teaching. A structured medication management visit tool for home health nurses will simplify the planning, interventions, and documentation of these visits to promote medication safety. Statement of Problem Home health nurses conducting medication management visits are given minimal guidance regarding what should be done during a medication management visit. Home health nursing schedules vary; not all nurses work each day that a patient needs a home health visit, and often, more than one nurse may visit the same patient throughout a medication management visit series, leading to a variation in teaching continuity. With a lack of structure and direction in 5 medication management visits and the demands of supporting patients with increasingly complex diagnoses and needs (Norlyk et al., 2020), many home health nurses lack the confidence to conduct these visits effectively, potentially causing a lack of thoroughness. Currently, there is no set tool or procedure to provide the needed structure to guide home health nurses through conducting a medication management visit in the patient’s home. Furthermore, Spencer and Punia (2020) found that no ready-made tool for nurses to use in the education and engagement of patients post-discharge existed and suggested that such a tool would provide improved healthcare decisions. Nurses are crucial to preventing medication errors during the transition from hospital to home (Mardani et al., 2020). Preventing these medication errors requires nurses to be empowered within the healthcare system to provide patient education and collaborate with the interdisciplinary team (Mardani et al., 2020). With no formal guide for medication management visits in place, the responsibility of medication management visits falls directly on the individual nurse. An evidence-based tool for nurses to guide the medication management visit will help the nurse be confident that all elements of the medication teaching have occurred. Additionally, the tool facilitates accurate documentation and promotes interdisciplinary collaboration to ensure continuity of care (Spencer & Punia, 2020). This includes maintaining an up-to-date medication list so that clinicians, nurses, and hospital staff have consistent and accurate information when treating or communicating with the patient. The purpose of this MSN project is to create an evidence-based tool to add structure and guidance to the medication management visit to aid nurses in conducting this visit confidently. 6 Significance of the Project With a prevalence of decreased health literacy in hospitalized patients (Marks et al., 2022), post-acute medication education is becoming increasingly important and a more significant responsibility for home health nurses. Before discharge, patients receive medication teaching; however, there is a gap between what patients think they can do and what they are able to do when they are back in their homes (Schwartz et al., 2024). Home health nurses who utilize a structure to the medication management visits provided in the patient’s home can evaluate the patient’s knowledge about their medications, thus reducing the potential for post-acute medication errors and improving patient outcomes while avoiding costly rehospitalizations (Alqenae et al., 2020). This MSN project is significant because it will provide an evidence-based tool for nurses to guide their medication management visits to ensure medication information is covered and documented. This structure will support a natural coordination of care with other disciplines, simplify visit preparation, and improve patient outcomes. With an estimated 50% of adult patients experiencing medication error and 20% experiencing an adverse drug event after discharge (Alqenae et al., 2020) from the hospital, home health nurses play a critical role in improving patient medication safety by providing thorough medication reconciliation and education about medication side effects and interactions. Medication management can be a complex health maintenance task that has the potential to determine patient outcomes (Schwartz et al., 2024). A structured visit tool supports necessary interdisciplinary collaboration and communication (Norlyk et al., 2020) in addition to adequate documentation (Centers for Medicare & Medicaid Services, 2023) for patient care and medication safety in the home. 7 Finally, the medication management visit tool will help the nurse fulfill their role effectively while reducing the work required to document the medication teaching, medication reconciliation, and patient response (Mardani et al., 2020). 8 Review of the Literature This literature review aims to examine current research on medication management in elderly post-acute patients and its impact on patient outcomes to develop an effective structure for medication management visits in home health care. The PICOT question providing the aim for this literature review is: In home health nurses (P) conducting medication management visits (I), does using a structured tool for guiding the medication management visit vs. not using the structured tool (C) affect nurses’ confidence and satisfaction with performing medication management visits (O) in a two-month period (T)? Framework The Johns Hopkins Nursing Model will be used as the evidence-based model to guide this project. This model offers simplicity and precise alignment with the project's phases, including planning, implementation, evaluation, and communication—essential to ensure successful execution (Gawlinski & Rutledge, 2008). The structured approach of the Johns Hopkins Nursing Model aligns well with the demands of home care settings, as it provides a clear, step-by-step framework to implement evidence-based interventions and improve care quality systematically (Dang & Dearholt, 2018). When implemented cyclically, this model will provide iterative improvements in the medication teaching visits provided to this homecare population. Planning, the first step in the Johns Hopkins Nursing Model, is essential to the success of this project. The planning phase will include a literature review to evaluate best practice in medication management visits and the most effective teaching methods for this elderly postacute population. In addition, nurses will be surveyed during this step to determine their level of 9 confidence and satisfaction when conducting medication management visits in the current structure. During the project's implementation phase, a visit structure tool will guide home health nurses in the interventions needed during each medication management visit. The primary stakeholders for this project will be the Executive Leadership Team (ELT) and the nurse educators. Support from these two groups will be crucial to the project's success. A short slide presentation will facilitate the presentations to educators and administration to achieve buy-in. Finally, nurses will be educated on the new medication management process using various methods, including education presentations, visual reminders, process flow sheets, role play, and demonstrations. The evaluation and communication steps will occur after the tool has been in place for two months. At this point, a post-survey will compare how this tool impacts nurses’ confidence and satisfaction with medication management visits and documentation. ELT and nurse educators will review the results and provide feedback. Communication can occur with other homecare units, sharing what has been working and what needs more improvement. Strengths and Limitations The Johns Hopkins Nursing Evidence-Based Practice (EBP) Model offers several strengths and limitations that impact its effectiveness in guiding this project. One strength of the model is the structured and systematic approach, simplifying the process into phases, making it easy to follow and apply (Dang & Dearholt, 2017). This structure encourages consistency in applying the project and promoting improved patient outcomes. Additionally, the model encourages interdisciplinary teamwork and communication (Newhouse et al., 2007). 10 One of the model’s drawbacks is its emphasis on formal evidence, such as randomized controlled trials (RCTs) (Gawlinski & Rutledge, 2008), overlooking the value of qualitative research and nurses’ experiences, which are equally crucial to the success of this project. While this model draws heavily on RCTs, feedback from nurses will play an essential role in implementing this project. However, the high level of evidence required by the Johns Hopkins model will provide a foundation of solid evidence, minimize bias, and effectively guide changes in practice made throughout this project. Analysis of Literature This literature analysis seeks to review current research on medication management during the transition from hospital to home, emphasizing elderly post-acute patients. The goal is to highlight the need for more structured guidance for homecare nurses during medication management visits. Standardized procedures and clear directives should be developed rather than requiring nurses to design individualized teaching plans for each patient independently. This structure would enable nurses to confidently carry out medication management visits and provide patients with consistent, safe, and effective education on administering their medications. Search Strategies A literature search explored current evidence using Weber State University’s Stewart Library’s OneSearch and Advanced Search (which span multiple databases), CINAHL Complete, PubMed, and Ovid to search results. To keep information current, articles from 2019 through 2024 were primarily included. The search included keywords such as medication management in the elderly, patient medication errors, post-acute medication errors, home health intervention for medication management, patient education, patient medication education, 11 education methods, methods to avoid rehospitalization, and homecare education. A broad search was created by using various Boolean combinations of these keywords. Synthesis of the Literature A growing body of literature highlights the challenges and risks associated with medication errors and continuity of care during the transition from hospital to home, which can significantly affect patient outcomes (Alqenae et al., 2020; Flatman, 2021; Mardani et al., 2020). Three themes that emerged in this literature review include medication errors and safety, continuity of care and provider roles, and patient and family engagement (Manias et al., 2019; Schwartz et al., 2024). By synthesizing findings from various studies, this review provides insights into improving medication management practices to enhance patient safety and care quality in home health settings (Tomlinson et al., 2020). Medication Errors and Safety The theme of medication errors and safety in post-acute care settings is prevalent across various studies, which consistently highlight the challenges faced by elderly patients during transitions from hospital to home (Alqenae et al., 2020; Flatman, 2021; Mardani et al., 2020; Manias et al., 2019). Alqenae et al. (2020) conducted a systematic review identifying the high prevalence of medication errors during this transition, emphasizing that these errors often occur due to inadequate communication between healthcare providers and insufficient patient education. Flatman (2021) echoes these concerns, stressing that practical strategies are essential to reduce medication errors at hospital discharge, including better coordination between care teams and more straightforward patient medication instructions. Structured protocols and comprehensive support for healthcare providers and family members are paramount to ensuring medication safety during transitional care for elderly 12 patients. Mardani et al. (2020) further explore the role of nurses in managing medication safety during transitional care, identifying that errors frequently arise when there is a lack of structured processes for reviewing and managing medications as patients move across care settings. There is a need for well-defined protocols and sufficient support for healthcare staff to ensure accurate medication management. In a related study, Manias et al. (2019) review the involvement of family members in managing elderly patients' medications during care transitions, identifying that medication errors often occur when family members lack the necessary knowledge or resources to oversee complex medication regimens. Collectively, these studies emphasize that enhancing medication safety requires improved communication, education, and structured care coordination to minimize the risk of errors during hospital-to-home transitions. Continuity of Care and Provider Roles The theme of continuity of care and the roles of healthcare providers in managing medication transitions is a significant focus in the literature (Baqir, 2020). Mardani et al. (2020) highlight the crucial role of nurses in ensuring the safe management of medications during transitional care, noting that gaps in communication between hospital and home healthcare providers often disrupt the continuity of care. Their review suggests that nurses are in a pivotal position to mitigate these gaps by acting as mediators in the handover process, ensuring that patients and caregivers communicate and understand medication regimens. Manias et al. (2019) and Silveira et al. (2020) emphasize the importance of involving family members in medication management to enhance continuity of care. They stress that healthcare providers must equip family members with the necessary knowledge and resources to participate in medication management effectively. Without proper training or provider communication, the risk of medication errors and misunderstandings increases. 13 Consistent care after hospital discharge reduces the likelihood of medication-related issues. Tomlinson et al. (2020) and Mueller et al. (2020) conducted a systematic review and meta-analysis that examined interventions supporting medication continuity for older adults. They found that structured programs, such as medication reconciliation and follow-up assessments by healthcare providers, significantly improve outcomes. Norlyk et al. (2020) address the challenges in information infrastructure that often hinder smooth transitions from hospital to home. They point out that healthcare providers are crucial in managing these infrastructures and sharing accurate, timely information with community caregivers and patients. Together, these studies underscore the necessity of clear communication, structured processes, and the active involvement of healthcare providers to maintain continuity of care and optimize medication management during transitions. Patient and Family Engagement The theme of patient and family engagement in medication management during transitions from hospital to home is extensively explored in the literature, with many studies emphasizing the importance of involving both patients and their families to improve care outcomes (Aase et al., 2017; Fylan et al., 2018; Hardicre et al., 2021; Manias et al., 2019; Marks et al., 2022; Schwartz et al., 2024; Vincent & Amalberti, 2016). Manias et al. (2019) underscore family members' critical role in managing elderly patients’ medications, particularly during transitions between care settings. Their review highlights that family involvement can reduce the risk of medication errors, but only if healthcare providers actively engage and educate them on medication regimens. Providing patients and their caregivers with education and support is essential for safe medication management, particularly during the transition from hospital to home, where 14 engagement and clear communication can significantly improve adherence and outcomes (Aase et al., 2017; Vincent & Amalberti, 2016). Schwartz et al. (2024) explore how patients’ and their families’ performance of medication-related tasks affects patient-reported outcomes. They find that patient and caregiver empowerment through education and support improves medication adherence and safety. Their study suggests that assessing patient and caregiver competence is essential to handling medication tasks correctly, especially for older patients with complex medication needs. Hardicre et al. (2021) also examine the effort of involvement that older patients and their carers undertake during the transition from hospital to home. They emphasize that healthcare providers must recognize and support this labor, as effective patient and family engagement can bridge communication gaps and prevent medication-related harm. Their findings suggest that patients and their caregivers need to be included in decision-making processes and provided with clear, accessible information about medications. Lastly, Marks et al. (2022) and Fylan et al. (2018) both emphasize that having family teach others or repeat back instructions significantly improves patients’ and families' understanding of discharge medication instructions. Their studies found that patients and caregivers learning about medication use through this method were more confident and satisfied with the discharge process, leading to better medication adherence and reduced errors. These studies collectively affirm the necessity of patient and family engagement, with a strong focus on providing education, resources, and communication to empower them to manage medications safely and effectively during transitions. Summary of Literature Review Findings and Application to the Project The reviewed literature highlights several key factors that can inform the development of a medication management tool for home healthcare nurses, particularly in helping elderly post- 15 acute patients avoid medication errors in the two months following hospitalization. A central concern is the prevalence of medication errors and safety risks during the transition from hospital to home (Alqenae et al., 2020; Flatman, 2021). These errors often arise from poor communication between healthcare providers and patients and a lack of patient education. Developing a tool that standardizes communication and ensures clear patient and caregiver instructions could reduce these errors (Mardani et al., 2020). Studies emphasize that nurses are critical in managing medications during care transitions (Mardani et al., 2020). The proposed medication management tool could assist nurses in ensuring seamless care by offering protocols for medication reconciliation and follow-up assessments to improve patient outcomes (Tomlinson et al., 2020). Such a tool could also facilitate communication between hospital and home healthcare providers, preventing gaps that often lead to medication errors (Norlyk et al., 2020). Finally, patient and family engagement are crucial to medication management (Manias et al., 2019). The tool should incorporate elements that engage patients and their families in the medication management process, including educational resources and materials to ensure understanding of discharge instructions (Marks et al., 2022). By equipping caregivers with the necessary knowledge and resources, the tool can empower them to support medication adherence and reduce the risk of errors (Schwartz et al., 2024). This literature offers a foundation for developing a comprehensive medication management tool that enhances communication, ensures continuity of care, and promotes patient-family engagement while assisting nurses in tracking and conducting medication management visits—ultimately increasing nurse satisfaction with these visits. 16 Project Plan and Implementation A structured plan for implementing a medication management visit tool for home health nurses is outlined. The plan addresses the gaps identified in the literature review, including medication errors during care transitions and the lack of guidance for home health nurses performing medication management visits. The project focuses on improving nurses' confidence and satisfaction in conducting a medication management visit by providing a standardized tool for medication reconciliation, patient education, and documentation. Plan and Implementation Process The implementation process begins with developing a structured medication management visit tool based on evidence from the literature review. This tool guides home health nurses, ensuring medication reconciliation, patient teaching, and documentation are consistently and thoroughly completed during each visit (Mardani et al., 2020). The tool will document the engagement and involvement of an in-home caregiver to help with medication management and ensure patient success (Hardicre et al., 2021). The structured tool includes a checklist for medication reconciliation, education prompts for discussing medication side effects and interactions, and a documentation template aligned with agency standards. Nurses will receive training from the nurse educator prior to using the tool. The deliverables (included in the appendix) are: a) the pre-survey of home health nurses to assess confidence and satisfaction in conducting medication management visits, b) an educational presentation to introduce the nurses to the mediation management tool, c) the medication management tool to be used in each of five visits, and d) the post-survey to assess nurses’ confidence and satisfaction with conducting medication management visits post tool implementation. 17 After obtaining stakeholder buy-in, homecare nurses fill out a presurvey via email and will be assigned an in-person education time. The nurse educator will educate the nurses, using the educational tool in the appendix, and familiarize them with the medication management tool. The medication management tool will be available as a file on each nurse’s computer, as well as paper copies made available in the office. Nurses apply the medication management tool during the two-month implementation period when conducting medication management visits. After two months of use, feedback is gathered via an emailed post-survey assessing nurses’ confidence and satisfaction with performing medication management visits. The project setting is the home health agency environment, which varies across urban and rural areas. This diversity will allow for testing the tool’s adaptability and effectiveness across different patient populations and care delivery environments. Interdisciplinary Team The interdisciplinary team’s collaboration is essential to the project’s success. Effective teamwork will ensure that nurses receive adequate training, patients receive consistent education, and the medication education is documented accurately. This approach will improve nurse confidence and satisfaction in medication management visits and reduce medication errors, promoting better patient outcomes. By fostering a culture of collaboration, the project will enhance the overall quality of care provided by the home health agency (Centers for Medicare & Medicaid Services, 2023). Project Lead. The project lead is a registered nurse and MSN student who designs the implementation process and tools, oversees the implementation of the project and collaborates with other team members in ensuring the project's success. 18 Home Health Nurses. Home health nurses are the primary users of the tool and play a critical role in its implementation. The nurses will engage patients during visits to assess the clarity and effectiveness of medication education. Their insights into patient care and understanding of medication-related challenges are essential for refining and adopting the tool. They will provide feedback on its usability and effectiveness during the pilot phase (Schwartz et al., 2024). Nurse Educators. Nurse educators will conduct training sessions and support nurses throughout the implementation process. Their role is critical in ensuring nurses are confident and competent in using the tool. Educators will also act as liaisons between nurses and the leadership team, relaying feedback and troubleshooting issues (Mardani et al., 2020). Executive Leadership Team (ELT). The ELT will provide strategic oversight, resources, and approval for the project. Their role includes promoting organizational alignment and encouraging the adoption of the tool as a standard practice for medication management visits. Patients and Caregivers. Patients and caregivers are indirect recipients of the project. They will contribute by participating in the medication management visits and benefiting from better-structured visits. Description and Development of Project Deliverables Pre-Survey for Home Health Nurses Conducting Medication Management Visits (see Appendix A). To assess baseline nurse confidence and satisfaction in performing medication management homecare visits, a pre-survey was developed. This survey evaluates nurses’ understanding of the importance of structured medication management, familiarity with current practices, and perceived barriers to implementation. The pre-survey is crucial for identifying 19 educational needs and establishing a baseline for comparison with the post-survey results. Conducting a presurvey is supported by Aase, Laugaland, and Dyrstad (2017), who emphasize the importance of tailored educational interventions to address specific gaps in knowledge. Nurse Education PowerPoint Presentation (see Appendix B). A PowerPoint presentation was designed to guide the nurse educator in instructing nurses on performing medication management visits using the structured tool. This teaching strategy was selected to engage learners visually and interactively while providing practical examples. Research supports the use of multimedia presentations and active learning strategies to improve knowledge retention and application in clinical practice (Flatman, 2021). Home Health Medication Management Visit Tool (see Appendix C). The primary project deliverable is the structured medication management visit tool, which outlines instructions and objectives for each of the five visits. The tool is divided into sections, each addressing a specific aspect of medication management: 1. Visit 1: Medication Reconciliation 2. Visit 2: Side Effect Education 3. Visit 3: Caregiver Training and Contact Person Assignment 4. Visit 4: Medication Organization and Reinforcement 5. Visit 5: Sustainability Check and Follow-Up The tool ensures consistency and comprehensiveness across visits, promoting better patient outcomes and adherence. Studies such as those by Manias et al. (2019) highlight the importance of structured approaches in reducing variability and enhancing patient safety during care transitions. 20 Post-Survey for Home Health Nurses Conducting Medication Management Visits (see Appendix D). A post-survey will be administered two months after implementation to evaluate the effectiveness of the educational intervention and the structured tool. The post-survey assesses changes in nurses’ confidence and satisfaction in conducting mediation management visits. This method aligns with Kirkpatrick’s evaluation model, which emphasizes measuring knowledge acquisition and its application in practice (Hardicre et al., 2021). By integrating these materials—the pre-survey, PowerPoint presentation, structured visit tool, and post-survey—the project ensures a comprehensive approach to improving medication management practices in homecare nursing. Timeline The implementation of the project will follow a structured timeline to ensure organization and adherence to the established goals. In the first two weeks, a pre-survey will be administered to participating nurses to collect baseline data regarding their current practices and knowledge related to medication management (see Appendix A). Following this, during weeks three to five, nurse education sessions will be conducted using a PowerPoint presentation, incorporating case studies and interactive Q&A sessions to reinforce learning (see Appendix B). The structured medication management visit tool will be implemented during homecare visits from weeks six through fourteen, allowing nurses to apply the learned concepts in practice and evaluate their effectiveness in real-world scenarios (see Appendix C). In weeks fourteen and fifteen, a postsurvey will be administered to assess the intervention’s effectiveness and measure improvements in nursing practice (see Appendix D). In the final week, week sixteen, the survey results will be analyzed, and the findings will be presented to stakeholders to guide further improvements and 21 potential policy changes. A graphical timeline summarizing these implementation steps is provided (see Appendix E). This project aims to enhance medication management practices in homecare nursing through a structured approach that includes education, implementation of a standardized visit tool, and evaluation. The timeline ensures a systematic rollout, and the deliverables are designed to improve nurse confidence and satisfaction in medication management and patient outcomes. By following this plan, the project aligns with evidence-based practices and addresses critical gaps in transitional care. Project Evaluation The Medication Management Visit Tool's effectiveness will be assessed using formative and summative evaluation methods to measure its impact on nurses' confidence and satisfaction in conducting medication management visits. The evaluation will also determine the tool’s effectiveness in improving medication reconciliation, patient education, and documentation practices in home health settings. Formative evaluation will be conducted throughout the implementation phase to ensure the tool’s usability and relevance. Several strategies will be employed, including nurse feedback sessions, ongoing support from the nurse educator, randomized chart audits, and stakeholder input. During the first four weeks of implementation, participating home health nurses will provide qualitative feedback on the tool’s ease of use, clarity, and barriers to adoption. The nurse educator will also conduct follow-up discussions after nurses use the tool to address uncertainties and refine the educational intervention as needed. Additionally, randomized chart audits will be performed to verify whether the structured checklist within the tool is consistently completed and aligns with agency documentation standards. Mid-implementation discussions with the 22 Executive Leadership Team (ELT) will ensure that the tool remains aligned with organizational goals and resources, allowing for real-time adjustments before full implementation is completed. Summative evaluation will assess the overall effectiveness of the intervention in improving nurse confidence, satisfaction, and adherence to best practices. This will involve administering pre-and post-surveys, conducting medication reconciliation audits, and analyzing nurse satisfaction and confidence scores. Before training, a pre-survey (Appendix A) will be administered to establish a baseline measure of nurses’ confidence, satisfaction, and current practices in medication management visits. A post-survey (Appendix D) will be distributed two months after implementation to evaluate changes in these areas. Changes in nurse satisfaction and confidence scores between the pre-and post-surveys will be analyzed to determine the significance of improvements. Although patients and caregivers are not direct subjects of the evaluation, nurses will provide qualitative insights regarding caregiver involvement and patient comprehension of medication regimens, offering an additional perspective on the tool’s impact. The combination of real-time feedback, structured surveys, documentation audits, and statistical analysis ensures a comprehensive Medication Management Visit Tool evaluation. By integrating formative and summative measures, this evaluation will determine the tool’s effectiveness, usability, and sustainability in home health practice. The findings will inform future revisions, potential scalability, and integration into standardized agency protocols to enhance medication management practices. Ethical Considerations This project ensures that all participants are treated with respect, fairness, and confidentiality. Ethical considerations will be integrated into every project phase, including 23 recruitment, implementation, data collection, and analysis. The principles of social responsibility, non-discriminative behavior, diversity, and honesty will guide all interactions with participants and stakeholders. Social responsibility is reflected in the project's goal of improving medication management practices to enhance patient safety and nursing competency. By developing a structured Medication Management Visit Tool, this initiative seeks to reduce medication errors and improve patient education, ultimately promoting better health outcomes for diverse populations in urban and rural home health settings. The project will be inclusive and non-discriminatory, ensuring that all nurses, regardless of background or experience level, have equal access to the training and resources provided. Additionally, efforts will be made to consider the diverse needs of the patients, ensuring equitable access to medication education and adherence support. Simplified language, visual aids, and teach-back methods will reinforce understanding. Recognizing the varying levels of caregiving support among patients, the structured tool will include caregiver training components, equipping family members with the knowledge and skills needed to assist in medication management. By addressing these issues, the tool can help bridge gaps in healthcare access and reduce medication errors in vulnerable patients. Respect for participants' autonomy is fundamental in this project. Home health nurses will be invited to participate voluntarily, and their involvement will not impact their employment status or professional responsibilities. Nurses who choose not to participate will not face any consequences, and alternative professional development opportunities will remain available to them. Informed consent will be obtained before participation, ensuring that nurses fully understand the purpose of the project, their role, and the potential benefits and risks. 24 All data collected through pre-and post-surveys, chart audits, and qualitative feedback sessions will be anonymized to protect participants' privacy. Individual responses will be de-identified before analysis to maintain confidentiality. Data will be stored securely on password-protected systems, and access will be restricted to the project lead and authorized personnel. Any published findings will present aggregate data rather than individual responses to prevent the identification of participants. Honesty and integrity will be maintained throughout the project by ensuring that all information shared with stakeholders is accurate, transparent, and free from bias. The findings will be reported objectively, including both strengths and limitations of the project. By adhering to these ethical principles, the project will foster trust among participants, uphold professional standards, and contribute to improving home health nursing practices. Discussion Implementing the Medication Management Visit Tool will enhance medication reconciliation, patient education, and documentation practices among home health nurses. By providing a structured approach, the tool supports improved nurse confidence and satisfaction in conducting medication management visits, ultimately contributing to better patient outcomes. This discussion explores evidence-based dissemination strategies, the project's significance for advancing nursing practice, potential challenges, and future research and implementation recommendations. Evidence-Based Solutions for Dissemination Dissemination of the project findings is critical to ensuring that the benefits of the Medication Management Visit Tool reach beyond the initial implementation site. The “3 Ps” of dissemination—poster, podium, and publication—will be employed to effectively share the 25 project’s results. The project will be presented to peers and faculty in a poster format, allowing discussion and feedback. Additionally, the project may be shared via podium presentations at local nursing conferences, such as state home health association meetings or quality improvement summits, where best practices in medication reconciliation are discussed. Another key dissemination strategy includes publication in peer-reviewed nursing journals such as Home Healthcare Now or The Journal of Nursing Care Quality that other home health nurses, nurse educators, and healthcare leaders can access and apply the evidence-based intervention. Furthermore, internal dissemination within the home health agency can occur through staff meetings, in-service training sessions, and quality improvement reports, facilitating broader organizational adoption of the structured medication management approach. Significance to Advance Nursing Practice The Medication Management Visit Tool is designed to address a critical gap in home health nursing by standardizing medication reconciliation practices. The significance of this project is in the potential to improve patient safety, enhance nursing efficiency, and reduce medication errors during home health visits. Medication errors are a prevalent issue in transitional care, with studies showing that up to 40% of medication discrepancies occur after hospital discharge (Manias et al., 2019). By equipping nurses with a structured framework for medication management, this project enhances their ability to identify and resolve discrepancies, thereby reducing the risk of adverse drug events. Furthermore, this project contributes to the professional development of home health nurses by increasing their confidence and satisfaction in conducting medication reviews. Aase, Laugaland, and Dyrstad (2017) emphasize the importance of tailored educational interventions to enhance nursing competency in transitional care settings. This project aligns with their findings 26 by integrating training sessions with a structured tool, ensuring nurses feel more prepared to navigate complex medication regimens. Implications The implementation of the Medication Management Visit Tool presents both strengths and limitations. One key strength is the tool’s ability to standardize medication management visits, ensuring consistency in documentation, patient education, and caregiver engagement. This structured approach reduces variability in nursing practice, which is essential for improving medication safety and adherence. Potential limitations include varying levels of nurse engagement, resistance to adopting new documentation methods, and challenges sustaining long-term use. To reduce obstacles, ongoing education and leadership support will be critical. Providing refresher training sessions and direct mentorship from nurse educators can help maintain engagement (Mardani et al., 2020). Implementing this project supports nursing knowledge and the profession by reinforcing the importance of structured medication reconciliation practices. It aligns with broader healthcare quality initiatives, such as the Centers for Medicare & Medicaid Services (CMS) guidelines on medication safety (CMS, 2023). By integrating evidence-based tools into practice, the project contributes to the ongoing effort to reduce medication-related hospital readmissions and improve patient outcomes. Recommendations There are recommendations to enhance the impact and sustainability of the Medication Management Visit Tool. First, expanding the project’s reach by including interdisciplinary collaboration with pharmacists and primary care providers could strengthen medication 27 reconciliation efforts. Additionally, future iterations of the tool could integrate electronic health record (EHR) prompts to streamline documentation and reduce manual workload. Future research should explore patient outcomes associated with tool implementation. While this project focuses primarily on nurse confidence and satisfaction, future studies could examine patient medication adherence, reduction in hospital readmissions, and caregiver engagement levels. Conclusion Implementing the Medication Management Visit Tool represents a meaningful advancement in home health nursing by standardizing medication reconciliation, improving nurse confidence, and enhancing patient education. The literature review highlighted the prevalence of medication errors during care transitions and the need for structured interventions (Manias et al., 2019). This project successfully addressed this gap by developing a tool that aligns with best practices in medication safety and nursing education. The project’s findings will be disseminated to ensure its benefits extend beyond the initial implementation setting. While challenges such as resistance to change and documentation variability may arise, targeted education and leadership support can mitigate these obstacles. Future research should explore patient-centered outcomes and interdisciplinary collaboration to enhance the tool’s effectiveness. Overall, this project contributes to the advancement of nursing practice by promoting standardized, evidence-based approaches to medication management, ultimately leading to improved patient safety and better healthcare outcomes in home health settings. 28 References Aase, K., Laugaland, K. A., & Dyrstad, D. N. (2017). Quality and safety in transitional care: Improving the quality of healthcare transitions for patients and professionals. Springer. Alqenae, F. A., Steinke, D., & Keers, R. N. (2020). Prevalence and nature of medication errors and medication-related harm following discharge from hospital to community settings: A systematic review. 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Patient Education and Counseling 104(2021), 1681-1703. https://doi.org/10.1016/j.pec.2020.12.010 The Joint Commission. (2022, April). Transitions of care: Managing medications. https://www.jointcommission.org/-/media/tjc/newsletters/qs-26-update2-4-21-22.pdf Tomlinson, J., Cheong, V.-L., Fylan, B., Silcock, J., Smith, H., Karban, K., & Blenkinsopp, A. (2020). Successful care transitions for older people: a systematic review and metaanalysis of the effects of interventions that support medication continuity. Age & Ageing, 49(4), 558–569. https://doi-org./10.1093/ageing/afaa002 Vincent, C. A., & Amalberti, R. (2016). Safer Healthcare: Strategies for the real world. Springer. https://doi-org/10.1007/978-3-319-25559-0 World Health Organization. (2024). Medication without harm. https://www.who.int/initiatives/medication-without-harm 31 Appendix A Pre-Survey for Home Health Nurses Conducting Medication Management Visits 1. How confident are you in conducting an effective medication management visit? • Very confident • Somewhat confident • Neutral • Somewhat unconfident • Very unconfident 2. How would you rate your current knowledge of best practices in medication management for home health? • Excellent • Good • Average • Poor • Very poor 3. How effective do you think your current methods of medication management teaching are in preventing errors? • Very effective • Somewhat effective • Neutral • Somewhat ineffective • Very ineffective 4. How satisfied are you with your current method of providing medication management visits? • Excellent • Good • Average • Poor • Very poor 32 Appendix B Nurse Education PowerPoint Presentation 33 34 35 Appendix C Home Health Medication Management Visit Tool Visit 1: Medication Reconciliation Objectives: • Verify all current medications (prescription, over-the-counter, supplements, herbal products). • Identify any discrepancies, duplicates, or contraindications. • Document an accurate and updated medication list. Checklist: 1. Obtain the patient’s complete medication list from: o Discharge summary (if applicable). o Pharmacy records. o Patient’s physical supply of medications. 2. Confirm: o Name, dose, route, frequency, and purpose of each medication. o Prescribing provider for each medication. 3. Review the patient’s adherence and identify any barriers: o Missed doses. o Financial concerns. o Adverse effects. 4. Document findings and discuss them with the patient and their caregiver. Patient caregiver: _________________________________ Phone number:________________ Pharmacy:________________________________________ Phone number:________________ Provider:_________________________________________ Phone number:________________ Name Dose Route Frequency Purpose Prescribed by: 36 Visit 2: Education About Side Effects Objectives: • Provide clear and understandable information about potential side effects. • Encourage the patient to report any adverse reactions promptly. Checklist: 1. Review each medication: o Common side effects. o Serious side effects requiring immediate attention. 2. Use teach-back method to confirm understanding: o Ask the patient to explain potential side effects in their own words. o Document their understanding. 3. Provide written materials or resources tailored to the patient’s literacy level. 4. Identify a plan for reporting side effects: o Contacting the home health nurse or physician. o Emergency procedures for severe reactions. Visit 3: Caregiver Teaching and In-Home Contact Person Assignment Objectives: • Teach caregiver medication management strategies. • Solidify the appointment of an in-home contact person for medication assistance. • Document caregiver competency using the teach-back method. Checklist: 1. Identify caregiver(s) involved in medication management: o Assess willingness and capacity. 2. Teach: o Medication schedule. o Administration techniques (if applicable). o Importance of consistency and adherence. 3. Confirm understanding: o Use teach-back method. o Document caregiver’s ability to correctly explain and demonstrate tasks. 4. Finalize: o Assign in-home contact person. o Obtain caregiver’s acknowledgment of responsibilities. 5. Receive a list of current medications: o Ensure this list matches the reconciled list from Visit 1. Visit 4: Teaching Reinforcement and Medication Organization Objectives: • Reinforce prior education and address any gaps in understanding. • Organize medications for daily use. Checklist: 1. Review previously taught material: o Address any questions or concerns. o Reassess understanding using teach-back. 2. Assist in setting up medication planners or pill packs: 37 Weekly pill organizer. Pharmacy-provided blister packs (if applicable). 3. Confirm delivery of medications from local pharmacy: o Ensure the correct supply and quantity of medications. o Check for any new medications or changes. o o Visit 5: Wrap-Up and Sustainability Check Objectives: • Reinforce medication management teaching. • Ensure a sustainable plan is in place for ongoing adherence. Checklist: 1. Review: o Patient and caregiver’s ability to manage medications. o Understanding of side effects and reporting process. o Use of medication planners or pill packs. 2. Confirm sustainability: o Check for continued adherence. o Identify any new barriers or challenges. o Provide additional resources or referrals if needed. 3. Perform a final check for side effects: o Discuss any changes in symptoms. o Verify there are no unreported adverse effects. 4. Provide a detailed summary of the medication management plan: o Updated medication list. o Contact information for assistance. 5. Document: o Patient and caregiver’s acknowledgment of the plan. o Final assessment and recommendations. 38 Appendix D Post-Survey for Home Health Nurses Conducting Medication Management Visits 1. How confident are you in conducting an effective medication management visit? • Very confident • Somewhat confident • Neutral • Somewhat unconfident • Very unconfident 2. How would you rate your current knowledge of best practices in medication management for home health? • Excellent • Good • Average • Poor • Very poor 3. How effective do you think your current methods of medication management teaching are in preventing errors? • Very effective • Somewhat effective • Neutral • Somewhat ineffective • Very ineffective 4. How satisfied are you with your current method of providing medication management visits? • Excellent • Good • Average • Poor • Very poor 5. How would you rate the use of the Medication Management Visit Tool on improving your confidence and satisfaction with performing medication management visits effectively? • Very effective • Somewhat effective • Neutral • Somewhat ineffective • Very ineffective 39 Appendix E Timeline