Breaking Barriers to Patient Compliance

Nurses can enhance patient understanding of and adherence to their overall treatment plans by strengthening communication, rapport, and education.

It Starts with Communication

Asking the right questions and opening the lines of communication between patient and nurse can uncover critical barriers to treatment compliance.

• Pose questions in a constructive, problem-solving manner. For example, “I see that you have not been completing your daily exercises. I wonder if they are causing you too much pain, or if there is some other reason?”
• Try to relate personally to the patient to build a stronger therapeutic partnership. Get the patient to express what the nurse and care team can be doing to help them better meet their personal health goals.
• Set and adhere to a discussion agenda for every encounter. Begin with a discussion of the patient’s personal goals and issues before moving on, such as “First, tell me what concerns you most, and then we’ll discuss test results.”

Encouraging Cooperation and Participation

Explain to patients that they must take some responsibility for the outcome of their care and treatment. Let them know that everyone caring for them wants them to be successful in regaining their health.

• Clearly and explicitly convey the severity of the problem and the risks of not properly carrying out instructions. Give the patient an opportunity to ask questions and clarify the instructions.

• Find out if there are any underlying factors affecting compliance. For example, “It sounds as though you may be concerned about the medication’s possible side effects. Is that why you have not taken it as prescribed?”
• Identify any practical or logistical difficulties that may hinder compliance.
• End each encounter by having the patient verbalize at least one self-management goal.

Helping Patients Manage Logistics

Sometimes a patient’s noncompliance issue is out of their hands due to a lack of personal support at home or financial restraints. Uncover where those patients are struggling:

• Do health care information records note who can help your patient when they’re outside of the health care setting?
• Are patients asked whether they can get to appointments via car or public transportation, and are responses documented in the patient care record?
• If a patient lacks the physical or mental capacity to perform such essential tasks as changing dressings or picking up prescriptions, has a relative or friend been asked to assist, with the permission of the patient or legal guardian?
• Is the patient concerned about financial constraints such as out of pocket costs for treatment, or having to take time off of work?
• Document these concerns in the patient care record, and work with the patient and their primary care provider (with the patient’s permission) to find solutions.

Supporting the Effort with Documentation

To help staff deal with hostile, manipulative, or uncooperative patients, written protocols should be in place to help all staff respond to and deal with difficult patients and unacceptable behavior, such as belligerent voicemail messages or yelling at staff. This should also include ways to document and procedures for such common concerns as repeated prescription refill requests of questionable nature, appointment or procedure cancellations, and neglecting to take medications, do exercises, or make necessary lifestyle changes.

Monitoring Compliance

Driving patient compliance often means health care teams need to repeat themselves again, and again, and again. Different tools can help nurses drive compliance, such as telephone and/or email reminders, and making a point to schedule follow up and referral appointments before patients leave the facility. Nurses should also document no-shows and conduct telephone follow-up within 24 hours.

Know if there is a written policy for terminating the patient-provider relationship if the patient is chronically noncompliant and fails to respond to reminders and other messages.

Keep at It

Patient noncompliance is a deep issue with no easy answers or simple solutions. Nurses in almost any setting will encounter noncompliant patients, but with consistent communication and a persistent, but cooperative, spirit nurses can work to overcome the risk of noncompliance one patient at a time. Nurses also can explore Nurses Service Organization’s patient self-assessment checklist to help facilitate open communications.¹

Resources

1. CNA and Nurses Service Organization. Patient Compliance: A Self-assessment Checklist. 2015. Retrieved from: http://www.nso.com/Documents/RiskEducation/Businesses/CNA_HP15-7_SelfAssess_Checklist.pdf

Adapted from Breaking Barriers to Patient Compliance by Jennifer Flynn, CPHRM, which originally appeared in Minority Nurse, and is used with permission from Nurses Service Organization (NSO).

Jennifer Flynn, CPHRM, Risk Manager, Nurses Service Organization, Healthcare Division, Aon Affinity, Philadelphia. Phone: (215) 773-4513. Email: Jennifer.Flynn@aon.com.

This risk management information was provided by Nurses Service Organization (NSO), the nation's largest provider of nurses’ professional liability insurance coverage for over 550,000 nurses since 1976. ARIN endorses the individual professional liability insurance policy administered through NSO and underwritten by American Casualty Company of Reading, Pennsylvania, a CNA company. Reproduction without permission of the publisher is prohibited. For questions, send an e-mail to service@nso.com or call 1-800-247-1500. www.nso.com.