Nursing Students Practicing Medication Reconciliation amongst Low-English Proficiency Patient Population in Clinic and via Telehealth

Purpose: The purpose of this nursing students’ evidence-based project, as part of a population health clinical rotation, is to abridge discrepancies and misunderstandings that persist in medication management for low-English proficiency patients, both via in-person interaction and via telehealth environment.

Background: At a clinic serving mostly low-English proficiency population, the nursing students encountered patients taking multiple medications for their chronic illnesses which made adhering to their medication a struggle. Several patients also experienced transportation challenges, resulting in the clinic setting up telehealth encounters for them. This encounter led the students to curate an evidence-based individualized medication reconciliation approach for the patients, both with in-person clinic and via telemedicine environment.

Description: Evidence shows that involving the patient and their family members in medication prescription and education increases comprehension of medical conditions, health self-management, and satisfaction with health care, as postulated by the practices of patient- and family-centered care. The students’ intervention consisted of a group session on medication safety, followed by individual reviews of patients’ current medications and their medical records, under faculty supervision. The patients had family members present with them, as well as an interpreter. The students ensured that the patients and their family knew where to obtain refills, the purpose of each medication, and the frequency and time of day to take each. Students also participated in telehealth calls, working with nurse practitioner preceptor, conducting medication reconciliation with patients via interpreters. Families were also present with the patients during these visits.

Evaluation/outcome: As a result of the in-person medication reconciliation intervention, the patients became more aware of their medication regimen, where and how to obtain refills, and the importance of medication adherence. However, challenges such as transportation issues, limited available interpreters for an efficient 1:1 session resulted in a low number of patients served. In the telehealth setting, patients and family were more likely to have all their current medications with them. There is more flexibility to have an interpreter virtually, unlike the in-person environment. The increased accessibility of telehealth allowed patients who had transportation issues to be seen. However, not all patients have reliable internet access to allow high-quality calls. Many patients and families also struggled to confirm the medication names via telehealth.

Implication: Medication reconciliation activities should be considered for all nursing students as part of the clinical experience in ambulatory care settings as it is a valuable learning experience. When possible, engaging family members and interpreter if the patient has low-English proficiency in either the clinic setting or via telehealth may contribute to the patient’s better understanding of their medical management regimen.