NRS 465 Benchmark Capstone Project Change Proposal

Sample Answer

Elderly patients with chronic conditions like diabetes, stroke, and hypertension require various medications to maintain a quality life. They must ensure poly-pharmacy emanating from taking different types of medicines for these diseases.

Nonmedication adherence is a significant issue among this population as illustrated by existing research evidence that mobile phone applications to enhance medication adherence among the elderly population is considered an effective and evidence-based intervention that can help address the issue.

Cao et al. (2024) observe that using application-based reminders on smartphones can enhance medication adherence among the elderly. Peng et al. (2020) assert that through reminders, elderly patients can easily take medications as prescribed at the right time without forgetting.

The purpose of this paper is to discuss the proposed capstone change project focusing on the use of smartphone reminders to improve medication adherence among elderly patients.

Background of Clinical Problem

Non-medication adherence affects patient safety and quality of care with elderly patients being the most affected. Studies show that close to 50% of patients with chronic diseases do not take their medications as indicated or prescribed.

Alhabib et al. (2022) and Foley et al. (2022) assert that suboptimal medication adherence can worsen medical conditions, lower the quality of life, and increase both mortality and morbidity. Nonadherence to medications accounts for close to 50% of treatment failures, leads to about 125,000 deaths and is responsible for close to 25% of hospitalizations every year in the United States.

The Centers for Disease Control and Prevention (CDC) (2021) opines that medication non-adherence is a significant issue that affects all patients across ages with elderly individuals with chronic conditions being the most impacted due to several reasons like cognitive issues associated with aging.

In their study, Zeintouny et al. (2023) observed older patients with multiple medication use are the most affected population based on the number of prescribed medications they are supposed to take, especially those with comorbid conditions.

Sutlu et al. (2023) observe that medication non-adherence is a critical patient issue affecting elderly patients due to comorbidity and poly-pharmacy. Liu et al. (2023) state that elderly patients have increased risk factors for medication non-adherence due to cognitive reasons associated with aging, multi-comorbidity, and poly-pharmacy.

As such, existing literature and industry reports are categorical that medication non-adherence is a significant health issue that affects the elderly, particularly those living with multi-morbidity.

Clinical Problem Statement

Non-adherence to medication is a rising health problem that impacts the quality of care. Adherence to prescribed medications among the elderly is essential to avoid and reduce adverse effects. Medication adherence is important for patients to attain quality outcomes based on prescribed medications.

Conversely, non-adherence to medications increases the cost of care and length of stay in hospitals (Kumar et al., 2024). Elderly patients with chronic conditions endure poly-pharmacy due to various health conditions related to aging and old age leading to cognitive impairment.

Close to 50% of elderly patients do not adhere to medications, and this exacerbates their efforts to enhance health outcomes. Healthcare providers like nurses integrate evidence-based practice interventions to enhance medication adherence for elderly patients and improve outcomes.

Stewart et al. (2022) implore nurses to develop interventions to address medication non-adherence for better outcomes. Again, the American Medical Association (AMA) (2023) is categorical that medication non-adherence occurs among the elderly because of various reasons that include forgetfulness, lack of symptoms, beliefs on medications, poly-pharmacy, and misunderstanding among other factors.

Stewart et al. (2022) opine that non-adherence to medications is a global problem that comprises health and economic outcomes for patients, families, the healthcare system, and the community. Through their article on adherence, its definition and measurement, impact, and prevalence, the authors demonstrate that non-adherence is best understood by considering the interactions among individuals and specific diseases and treatments within existing social and environmental settings.

The authors advance that adherence is a product of motivation and ability where motivation focuses on conscious decision-making processes that emanate from instinctive, intuitive, and habitual aspects. Ability entails the physical and psychological skills required by patients to adhere to medicines as prescribed by physicians. In their study, Ge et al. (2023) explore the reasons and determinants of medication non-adherence among community-dwelling adults.

The cross-sectional study compared young and older age groups in these settings and showed that depressive symptoms were the main reason for medication non-adherence among elderly patients. As such, the clinical issue of non-adherence to medication requires effective intervention to improve patient outcomes and reduce the associated burden like increased cost of care, longer stays in hospitals, and exposure to comorbidity and even mortality.

Purpose of the Change Proposal to Offer Patient Care in the Changing Health Care System

The changing healthcare system requires interventions that lead to better patient outcomes for patients, their families, and healthcare facilities and providers. Effective interventions to reduce and prevent medication non-adherence will lead to better outcomes, and reduce the overall cost associated with non-adherence.

The changing healthcare system is embracing health technologies that include mHealth interventions such as smartphone reminders. The use of mobile phone application reminders shows the increasing role of health technologies in improving patient safety as a component of the ever-expanding telehealth and telemedicine aspects.

According to Almeman (2024), digital technologies are reshaping aspects of healthcare, including patient engagement and medication adherence. Holmgren et al. (2023) observe that technology is a critical tool to improve patient safety as it increases standardization and efficiency of clinical workflows and reduces errors and costs in all aspects.

As such, the proposed change focusing on enhancing medication adherence through mobile applications is an intervention aimed at improving patient safety, and outcomes, and reducing the cost of care.

The purpose of the change proposal is to recommend and implement medication adherence tools using mobile phone application reminders. Existing evidence is categorical that mobile apps can enhance medication adherence among elderly patients with chronic conditions like diabetes and hypertension.

Poorcheraghi et al. (2023) demonstrate the efficacy of mobile applications to improve drug adherence and reduce adverse events. Further, Blinker Jr. et al. (2022) note that smartphone medication reminder apps can support efforts and processes to lower non-adherence to medications among elderly patients.

Cao et al. (2024) also observe that mobile apps improve medication adherence among older adults who are stroke survivors. As such, this proposed project focuses on improving medication adherence among elderly patients suffering from chronic conditions.

The mobile apps are an illustration of the increasing role of technologies in creating change in healthcare and improving patient safety outcomes. As observed by Kumar et al. (2024), innovation in healthcare technology has significantly enhanced the efficiency of the healthcare system, especially with emerging diseases like the COVID-19 pandemic.

The surge in telemedicine services illustrates the changing nature of the health system and implementing solutions that are patient-centered and quality-driven.

PICOT Question

Based on feedback from the preceptor and peers, the refined PICOT question for the capstone proposed change project is;

In elderly patients with chronic diseases (P), how do medication reminder apps (I) compared to traditional reminder methods like alarms and written schedules (C) improve rates of medication adherence by 30% (O) within three months (T)?

Literature Search Strategy Employed

The capstone change project being proposed is founded on an extensive literature review of current studies comprising the problem and the suggested intervention.

As such, having an effective literature search approach is important to identify and determine articles with evidence on the implementation of the suggested intervention to enhance medication adherence among the selected patient population (Melnyk et al., 2022).

The paper searched for peer-reviewed articles by employing keywords that included medication adherence, chronic diseases and medication non-adherence, mobile apps in medication adherence, and prevalence of medication non-adherence among elderly patients.

The study selected articles from diverse databases published within the last five years. Based on this parameter, the oldest article was published in 2020. The study also selected various types of peer-reviewed journal articles that included randomized controlled trials (RCTs), cross-sectional studies, quasi-experimental studies, and systematic reviews.

The proposed capstone change project used PubMed Central, SAGE Journals, Google Scholar, Science Direct and Elsevier, and CINAHL Complete as databases for the different journals and journal articles to extract evidence supporting the intervention and elucidating the practice problem.

Synthesis of Literature Review

The reviewed literature supports the suggested intervention to improve medication adherence among elderly patients. A majority of the articles demonstrate the importance of the changing healthcare delivery system and increased integration of healthcare technologies to improve patient safety and outcomes.

These studies are categorical that non-adherence to medication is an increasingly prevalent issue with significant negative effects on patients and the healthcare system.

Elderly patients with chronic conditions suffer from increased rates of medication non-adherence because of aging, poly-pharmacy, and cognitive impairment like forgetfulness. The studies advance that using mobile applications (mHealth) reminders increases the rate of medication adherence and quality of life.

Li et al. (2021), Cao et al. (2021), and Poorcharghi et al. (2023) focus on the development and deployment of mobile apps to increase medication adherence among elderly patients in various healthcare settings and homes.

Harch et al. (2024) focus on the effectiveness of a smartphone application to enhance medication adherence while Volpi et al. (2021) determine that using these apps is a radical change to improving patient safety and ensuring attainment of better outcomes for such patients.

These studies are categorical that integration of mobile apps is a critical step to enhancing quality outcomes and improved safety for patients, especially elderly individuals with chronic comorbid conditions using various medicines at the same time.

In their systematic review and meta-analysis, Peng et al. (2020) demonstrate that mobile apps are effective interventions for better medication adherence for adults suffering from chronic diseases. The article is categorical that with low evidence and short intervention duration, these apps are essential in enhancing the increased adoption of mobile health technologies.

Again, Armitage et al. (2020) observe through their systematic review of randomized controlled trials with meta-analysis that mobile device apps demonstrate efficiency and can be tried in different settings to improve medication adherence.

Further, a systematic review and meta-analysis by Zhou et al. (2022) focusing on the effectiveness of mobile medication apps for individuals with chronic comorbidities in five countries including the United States, China, and France, show that they improve adherence by conveying medical solutions, offering educational support, and tracking medication, and enabling remote consultations.

As such, these studies are categorical that despite challenges and regulatory mandates on data privacy and confidentiality, these apps are revolutionizing medication adherence among elderly patients with chronic diseases.

A majority of the studies emphasize future investigations to determine the level of improvement because of the complex nature of these apps and the degree of understanding of the target population.

The synthesized literature shows beyond doubt that medication adherence as a critical patient concern requires effective solutions that leverage healthcare technologies for better optimal application. Nguyen et al. (2024) emphasize the importance of developing apps that are contextually sensitive to the target population based on their unique characteristics to improve medication adherence.

The study like others advances the importance of using these apps despite the need for future investigations to determine their overall efficacy for individuals with chronic conditions like diabetes and hypertension.

Applicable Change or Nursing Theory Utilized

Theories on change in nursing are essential when executing capstone change proposals like the use of mobile apps to improve medication adherence among elderly individuals with chronic conditions. Theories and change models help explore and understand different phenomena in organizational situations.

In this case, the proposed capstone change project will use Lewin’s three-step change process or model to implement the intervention. Lewin’s three-step theory comprises three stages that include unfreezing, change, and refreezing when executing new measures or changes in a clinical setting or organization (Burnes, 2020).

The three steps increase driving forces leading to the achievement of the desired outcomes and embedding them as part of the organizational culture to enhance patient outcomes.

In the unfreezing stage, the team will prepare the target population for a desired change while the change stage will focus on implementing the mobile app reminder system as part of the patient routine medication adherence practice.

Refreezing is to solidify and embrace the change once it proves effective and successful to the organization and the target health population, the elderly with chronic conditions (Burnes, 2020). As such, Lewin’s change model is simple and allows practitioners to engage patients based on the desired change and its three stages.

Proposed Implementation Plan with Outcome Measures

The proposed intervention is to employ mobile apps to improve medication adherence among elderly patients suffering from chronic conditions with comorbidities. The integration of the mobile apps is based on the core objectives of the proposed change which include increasing adherence by 30% within three months, empowering patients to make better decisions and choices, improving poly-pharmacy and managing comorbidity, and enhancing inter-professional collaboration and approaches to patient health promotion.

The implementation of the proposed intervention will comprise standard steps that include assessment, identification, and development of the initiative, planning and developing the application, executing the intervention, and monitoring and evaluation (Melnyk et al., 2022).

The initial step would be to assess the level of the issues using data from current evidence. In this case, close to 50% of elderly patients with chronic conditions do not adhere to their medications.

Again, a significant number do not get reminded to take their medicines, especially those with comorbid chronic diseases. The planning aspect will seek software vendors and developers to create the application using the facility’s mHealth infrastructure and integrate it with the electronic health records.

Nurses will get trained on its working and how they can engage the target population (Melnyk et al., 2023). The team will then roll out the application using a pilot study of ten elderly patients within the facility to test its efficacy on medication adherence rates.

The pilot implementation will occur in two weeks and nurses collect data on missed reminders, effective reminders, and possible reminder fatigue among the target patients. Based on these outcomes, the facility will roll out the project as part of its change improvement process to enhance medication adherence among elderly patients with chronic conditions.

Nurses will monitor the uptake of medications among the target patients during the pilot weeks and implementation stages daily and weekly and offer reports to the organizational managers through the implementation team.

The collected data will determine gaps and what should be improved on the mobile apps for better outcomes and desired change (Melnyk et al., 2022). Evaluation will focus on the effectiveness and efficacy of the developed app to meet unique concerns and needs, particularly from a cultural perspective where those with certain cultural practices will be integrated based on their uniqueness.

The primary outcome of the proposed capstone change project is to improve medication adherence by 30% within three months among the targeted population. The proposed intervention will also enhance personal decisions and choices among patients as they familiarize themselves with apps to improve medications and lead to better outcomes (Dusetzina et al., 2023).

The rationale for the project is to ensure elderly patients with chronic conditions, especially comorbidities, have better outcomes based on effectively taking their medications are required or prescribed.

As such, the rationale, objectives, and expected outcomes illustrate respect for autonomy and self-determination for elderly patients with poor medication adherence levels despite their comorbidity.

Evaluation Plan

At the core of this evaluation plan is to ascertain the effectiveness of the proposed capstone change project on medication adherence among elderly patients. The evaluation plan will entail ascertaining the effects of mobile apps on medication adherence by collecting data before and after the implementation of the intervention.

The evaluation will use observational data collected by nurses each day and every week to determine the effectiveness of the proposed capstone change project to meet the first objective. The team will use satisfaction surveys on patients to determine their perceptions of making decisions and choices.

The third objective will collect data on medications and alerts on patients, the number of illnesses, and the frequency of taking medicines (Melnyk et al., 2022). The team will use collected data before and after the implementation to determine the overall effectiveness of the intervention and communicate findings to the organizational managers and leaders.

The team will evaluate the outcomes of the fourth objective by collating and analyzing data from questionnaires given to healthcare workers in the facility concerning the effectiveness of mobile apps in improving collaboration and approach to patient health promotion (Kumari et al., 2024). The evaluation plan (attached in the Appendix) will assess and analyze the overall impact of the proposed capstone change project to meet patient needs.

Potential Barriers to Implementation Plan and Overcoming Them

Implementing changes in organizations is associated with barriers that should be addressed to ensure a recommended project meets its set objectives. The first possible barrier to the project will be resistance to change from nurses and even patients who are used to the current situation or ways of doing things. Further, the project requires sufficient support and resources from the management.

This implies that without sufficient information, stakeholders can decline the intervention as employees may be skeptical of its implementation (Melnyk et al., 2022). Additionally, limited evidence-based practice (EBP) knowledge can also hamper effective implementation as nurses’ and patients’ beliefs play a critical role in swaying their perceptions and acceptance of the proposed intervention.

Overcoming these barriers is important to attain the set goals and objectives of the proposed interventions. As demonstrated in the evaluation plan, communication is a core part of getting acceptance across all stakeholders. Effective communication will enhance the engagement of stakeholders while better approaches to resource mobilization shall ensure that the project meets organizational needs and goals (Melnyk et al., 2022).

A collaborative approach through a multidisciplinary team and implementation of simple change models like Lewin’s three-step change process will be critical to overcoming these hurdles. As such, the selected team should work collaboratively to implement the change and enhance medication adherence levels for elderly patients with chronic conditions.

Conclusion

Medication non-adherence is a significant challenge to patients with evidence showing that close to half of patients do not adhere to their medicines as prescribed by providers. The increasing change in healthcare through better technologies like mobile apps can help improve medication adherence among patients with chronic conditions.

The proposed capstone change project focuses on implementing mobile apps to improve medication adherence among elderly patients with chronic conditions, especially those with comorbidities.

References

• Almeman, A. (2024). The digital transformation in pharmacy embracing online platforms and
  the cosmeceutical paradigm shift. Journal of Health, Population and Nutrition, 43(1) 60. DOI https //doi.org/10.1186/s41043-024-00550-2
  Alhabib, M. Y., Alhazmi, T. S., Alsaad, S. M., AlQahtani, A. S., & Alnafisah, A. A. (2022).
  Medication adherence among geriatric patients with chronic diseases in Riyadh, Saudi Arabia. Patient Preference and Adherence, 16 2021-2030.
  DOI 10.2147/PPA.S363082
  
• American Medical Association (AMA) (2023 February 22). 8 reasons patients don’t take their
  medications.https //www.ama-assn.org/delivering-care/physician-patient-relationship/8-reasons-patients-dont-take-their-medications
  Armitage, L. C., Kassavou, A., & Sutton, S. (2020). Do mobile device apps designed to support
  Does medication adherence demonstrate efficacy? A systematic review of randomized controlled trials, with meta-analysis. BMJ open, 10(1) e032045. https //doi.org/10.1136/bmjopen-2019-032045
  Brinker Jr., D. L., Foley, K. A., Zhou, Y., Acevedo-Callejas, M., Li, Y., & Farrell, E. L. (2022).
  Use of a smartphone medication reminder application to support emerging adult adherence to non-antibiotic treatment for viral upper respiratory tract infection. Journal of Primary Care & Community Health, 13, 21501319221129732. DOI 10.1177/21501319221129732
  
• Burnes, B. (2020). The origins of Lewin’s three-step model of change. The Journal of Applied
  Behavioral Science, 56(1) 32-59. https //doi.org/10.1177/0021886319892685
  Cao, W., Wang, J., Wang, Y., Hassan, I. I., & Kadir, A. A. (2024). mHealth App to improve
  medication adherence among older adult stroke survivors Development and usability study. Digital Health, 10, 20552076241236291. https //doi.org/10.1177/20552076241236291
  
• Dusetzina, S. B., Besaw, R. J., Whitmore, C. C., Mattingly, T. J., Sinaiko, A. D., Keating, N. L.,
  & Everson, J. (2023). Cost-related medication non-adherence and desire for medication cost information among adults aged 65 years and older in the US in 2022. JAMA Network Open, 6(5), e2314211-e2314211. DOI 10.1001/jamanetworkopen.2023.14211
  
• Foley, L., Larkin, J., Lombard-Vance, R., Murphy, A. W., Hynes, L., Galvin, E., & Molloy, G. J.
  (2021). Prevalence and predictors of medication non-adherence among people living with multi-morbidity a systematic review and meta-analysis. BMJ Open, 11(9) e044987. DOI 10.1136/bmjopen-2020-044987
  
• Ge, L., Heng, B. H., & Yap, C. W. (2023). Understanding the reasons and determinants of
  medication non-adherence in community-dwelling adults a cross-sectional study comparing young and older age groups. BMC Health Services Research, 23(1) 905. DOI https //doi.org/10.1186/s12913-023-09904-8
  
• Holmgren, A. J., McBride, S., Gale, B., Mossburg, S. (2023 March 29). Technology as a Tool
  for Improving Patient Safety. Patient Safety Network. https //psnet.ahrq.gov/perspective/technology-tool-improving-patient-safety
  Kumari, R., & Chander, S. (2024). Improving healthcare quality by unifying the American
  electronic medical report system time for change. The Egyptian Heart Journal, 76(1)
  32. DOI 10.1186/s43044-024-00463-9
  
• Liu, J., Yu, Y., Yan, S., Zeng, Y., Su, S., He, T., … & Yue, X. (2023). Risk factors for self-
  reported medication adherence in community-dwelling older patients with multi-morbidity and poly-pharmacy a multicenter cross-sectional study. BMC Geriatrics, 23(1) 75. DOI https //doi.org/10.1186/s12877-023-03768-7
  
• Melnyk, B. M., & Fineout-Overholt, E. (2022). Evidence-based practice in nursing &
  Healthcare A Guide to Best Practice. Lippincott Williams & Wilkins.
  Mykyta, L., & Cohen, R. A. (2023). Characteristics of Adults Aged 18–64 Who Did Not Take
  Medication as Prescribed to Reduce Costs United States, 2021. National Center for Health Statistics. https //www.cdc.gov/nchs/products/databriefs/db470.htm
  Nguyen, A., Uppal, S., Pereira, M. M., Pluti, A., & Gualtieri, L. (2024). MedHerent Improving
  Medication Adherence in Older Adults With Contextually Sensitive Alerts Through an Application That Adheres to You. Mayo Clinic Proceedings Digital Health, 2(1) 1-7. https //doi.org/10.1016/j.mcpdig.2023.11.001
  Peng, Y., Wang, H., Fang, Q., Xie, L., Shu, L., Sun, W., & Liu, Q. (2020). Effectiveness of
  mobile applications on medication adherence in adults with chronic diseases a systematic review and meta-analysis. Journal of Managed Care & Specialty Pharmacy, 26(4) 550-561. DOI 10.18553/jmcp.2020.26.4.550.
  
• Poorcheraghi, H., Negarandeh, R., Pashaeypoor, S., & Jorian, J. (2023). Effect of using a mobile
  drug management application on medication adherence and hospital readmission among elderly patients with poly-pharmacy a randomized controlled trial. BMC Health Services Research, 23(1), 1192. DOI https //doi.org/10.1186/s12913-023-10177-4
  
• Stewart, S. J. F., Moon, Z., & Horne, R. (2023). Medication nonadherence health impact,
  prevalence, correlates, and interventions. Psychology & Health, 38(6) 726-765.
  https //doi.org/10.1080/08870446.2022.2144923
  
• Sütlü, S. (2023). Medication Adherence and its Affecting Factors among Older Adults. Anatolian
  Journal of Family Medicine, 6(2) 81-86. DOI 10.5505/anatoljfm.2023.83030
  
• Volpi, S. S., Biduski, D., Bellei, E. A., Tefili, D., McCleary, L., Alves, A. L. S. A., & De
  Marchi, A. C. B. (2021). Using a mobile health app to improve patients’ adherence to hypertension treatment a non-randomized clinical trial. Peer J, 9, e11491. DOI 10.7717/peerj.11491
  
• Zeitouny, S., Cheng, L., Wong, S. T., Tadrous, M., McGrail, K., & Law, M. R. (2023).
  Prevalence and predictors of primary nonadherence to medications prescribed in primary care. Canadian Medical Association Journal, 195(30), E1000-E1009.
  DOI 10.1503/cmaj.221018
  
• Zhou, T., Wang, R., Jia Gu, S., Ling Xie, L., Hua Zhao, Q., Zhao Xiao, M., & lu Chen, Y. (2022).
  Effectiveness of Mobile medical apps in ensuring medication safety among patients with chronic diseases systematic review and meta-analysis. JMIR mHealth and uHealth, 10(11) e39819. DOI 10.2196/39819