Teach Back - PowerPoint Presentation

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Teach Back

Improving Patient Education

Janet Grace, RN, BSN

Saline Memorial HospitalSlide2

Objectives

Define teach-back and its purpose

Describe the key elements for using teach-back correctly

Apply in the clinical settingSlide3

The Challenge

40-80% of medical information patients receive is forgotten immediately and nearly ½ of the information retained is wrong. Slide4

The Challenge

A common quote states we retain:

10% of what we read

20% of what we hear

30% of what we see

50% of what we see and hear

70% of what we discuss with others

80% of what we experience

95% of what we teach to someone else

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Printed Discharge Instructions

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you have a ypocsonoloc. Ypocsonoloc

is a test for noloc recnac. It sevlovni

gnitresni a elbixelf gniweiv epocs

into your mutcer. You must drink a

laiceps diuqil the thgin erofeb the

noitanimaxe to naelc out your noloc.Slide6

What it Says….

Your physician has recommended that you have a colonoscopy. Colonoscopy is a test for colon cancer. It involves inserting a flexible viewing scope into your rectum. You must drink special liquid the night before the examination to clean out your colon.Slide7

What does this mean?

There is a bear in a plain wrapper doing flip flops on 78 handing out green stamps. Slide8

What does this mean?

There is a policeman in an unmarked car going up and down highway 78 handing out tickets.Slide9

The Right to Understand

Patients have the right to understand healthcare information that is needed for them to safely care for themselves

Healthcare providers have a duty to provide information in a simple, clear, and plain language AND to check that the patients have understood the information Slide10

Universal Communication Principles

Everyone benefits from clear information

Many patients are at risk for misunderstanding but it is difficult to identify them

Knowing the patient’s level of education does not ensure patient understanding Slide11

When Communicating with Patients and Families

Always:

Use plain language

Slow down

Break it down into short sentences

Focus on the 2 or 3 most important concepts

Check for understanding using teach-back Slide12

What is Teach Back?

Teach back is asking patients to repeat in their own words what they have learned

It is not a test of the patient, but of how well YOU explained the concept

It is a chance to check for understanding and, if necessary, re-teach the information Slide13

Why Use Teach-Back?

Improves the ability to assess understanding of teaching

Allows feedback & corrections of mis- understandings immediately

Increases patient’s confidence in providing self-care

Encourages active patient/family participation

Improves the transition from hospital to home

Improves the overall safety and quality of careSlide14

Confirming Understanding

Ask patients to acknowledge understanding

using their own words

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Examples:

“I want to be sure I explained everything clearly. Can you please explain it back to me so I can be sure I did?”Slide15

Confirming Understanding

“What will you tell your husband about the changes that were made to your blood pressure medicines today?”

“We’ve gone over a lot of information, a lot of things you can do to get more exercise in your day. In your own words, please review what we talked about. How will you make it work at home?” Slide16

Confirming Understanding

Teach back provides the opportunity to confirm understanding BEFORE adding any new information.

Re-phrase the information IF the patient is unable to repeat the information accurately.

Ask them to repeat the information again using their own words.

Repeat the process until you are comfortable they really understand it.

If they still don’t understand it then consider other strategies.Slide17

Closing the LoopSlide18

Teach-back Additional Points

Do NOT ask yes/no questions like:

“Do you understand?”

“Do you have any questions?”

For more than one concept “Chunk and Check”:

Teach the 2-3 main points for the first concept & check for understanding using teach-back.

Then go to the next concept.Slide19

Teach Back Method

Uses statements such as:

“I want to make sure I explained everything clearly to you. Can you please explain it back to me in your own words?”

OR

“I want to make sure I did a good job explaining this to you because it can be very confusing. Can you tell me what changes we decided to make and how you will take your medicine now?”

If needed, clarify and reinforce the explanation to improve patient understanding.Slide20

Teaching the

Topic

The signs of heart failure:

Dyspnea on exertion

Weight gain from fluid retention

Edema in your lower extremities and abdomen

Fatigue

Dry, hacky cough

Difficulty breathing when supineSlide21

Teaching the Patient

I am going to talk to you about the signs of heart failure. The signs of heart failure are:

Shortness of Breath

Weight gain from fluid build-up

Swelling in feet, ankles, legs or stomach

Dry, hacky cough

Feeling more tired, no energy

It’s harder for you to breath when lying downSlide22

Teaching the Patient

I’m going to talk to you about what you need to do every day at home to control your heart failure. Every day:

Weigh yourself in the morning before breakfast and write it down

Take your medication the way you should

Check for swelling in your feet, ankles, legs and stomach

Eat low-salt food

Balance activity and rest periods

List four things for me that you are going to do everyday

What’s wrong with this? Shouldn’t be like a test.Slide23

Teaching the Patient – Teach Back Method

I’m going to talk to you about what you need to do every day at home to control your heart failure.” Every day:

Weigh yourself in the morning before breakfast and write it down

Take your medication the way you should

Check for swelling in your feet, ankles, legs and stomach

Eat low-salt food

Balance activity and rest periods

I teach people about this every day, and sometimes I go over it quickly or may not make myself clear. I want to make sure you know what you need to do. So, can you tell me some things you will do each day?Slide24

Discharge Info

When communicating follow-up appointment include:

Place, date, time

Access to transportation

Provider name and specialty

WHY they need to follow-up; be specific Slide25

Elements of Competence

Responsibility is on the provider

Use a caring tone of voice and attitude

Use PLAIN language

Ask the patient to explain using their own words – NOT yes/no

Use for all important patient information, specific to the condition

Document use of & response to teach-back.Slide26

Other

Without teach-back the only indicator of misunderstanding may be a medication error.

You might be surprised at the misconceptions patients have about their discharge instructions.

Nonverbal cues are not always reliable.

Include caregivers when giving discharge instructions- using Teach Back. Slide27

Questions to Consider

What are specific topics or directions you commonly discuss with your patient that you can use the teach-back method with?

Ideas: insulin injections, medications, chronic disease self-care, etc.

Inadequate knowledge of insulin, oral hypoglycemics and anticoagulants are common reasons for readmission Slide28

Practicing Teach Back Method

Each participant will participate in a role-play providing education to a patient. The following will be assessed:

Ability to do teach back in a shame-free way, e.g. tone is positive

Utilizes plain language for explanations

Does NOT ask patient, “Do you understand?”Slide29

Acknowledgements

The Iowa Health System Health Literacy Collaborative

Santa Clara Valley Medical System in collaboration with Educational Services at Children’s Hospital of WI – 2010

www.nchealthliteracy.org

http://www.ahrq.gov

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Practice Teach Back