Impact of Pharmacist-Led Bedside Medication Education and Nursing Workflow Enhancements on HCAHPS Medication Communication Scores: A Pre-Post Implementation Quality Improvement Study.

Abstract

Objective: The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey evaluates whether patients understand the purpose and potential side effects of newly prescribed medications. These measures affect patient experience metrics and may influence Centers for Medicare & Medicaid Services (CMS) reimbursement. Prior studies have suggested pharmacist-led counseling may improve medication-related HCAHPS outcomes.

Methods: This pre-post quality improvement initiative was conducted across 19 inpatient units at an 897-bed community hospital. Four units with historically lower side-effect communication scores received pharmacist- and student pharmacist-led bedside medication education (BME) for newly initiated medications. Counseling addressed medication indication, common adverse effects, and teach-back. Completed education was documented on patient room whiteboards to notify nursing staff. Concurrently, all inpatient units implemented an electronic medication administration record (eMAR) enhancement that incorporated medication side-effect prompts into nursing workflows. Average unit-level HCAHPS Medication Communication scores from January through July 2024 and January through July 2025 were compared using a paired t-test.

Results: During the 7-month intervention period, 1952 HCAHPS survey responses were received. The four targeted units completed 2503 BME encounters covering 3162 medications. Commonly discussed medication classes included anti-infectives (n = 1359; 43%), anticoagulants (n = 1304; 41.2%), diuretics (n = 402; 12.7%), and corticosteroids (n = 97; 3.1%). Across 19 inpatient units (n = 19), mean Medication Communication scores increased from 52% pre-intervention to 58% post-intervention, representing a mean increase of 6.08 percentage points (95% CI, 2.34-9.81; P = .003). Indication scores increased from 70.0% to 74.5%, and side-effect scores increased from 40.4% to 45.3%. Units receiving both BME and eMAR enhancements (n = 4) demonstrated increases of 1.3% and 5.6% in indication and side-effect scores, respectively. Units receiving only the eMAR enhancement (n = 15) demonstrated increases of 7.9% and 4.3%, respectively.

Conclusions: Combining pharmacist-led bedside counseling with eMAR-supported nursing workflows was associated with a statistically significant increase in HCAHPS Medication Communication performance. Pharmacist involvement appeared particularly beneficial for side-effect communication, while eMAR enhancements supported broader improvements in medication indication education. These findings suggest that combined personnel- and workflow-based strategies may strengthen patient medication education and experience metrics.