Teach Back

1. Teach Back Improving Patient Education Janet Grace, RN, BSN Saline Memorial Hospital

2. Objectives • Define teach-back and its purpose • Describe the key elements for using teach-back correctly • Apply in the clinical setting

3. The Challenge • 40-80% of medical information patients receive is forgotten immediately and nearly ½ of the information retained is wrong.

4. 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

5. Printed Discharge Instructions Your naicisyhp has dednemmocer that 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.

6. 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.

7. What does this mean? • There is a bear in a plain wrapper doing flip flops on 78 handing out green stamps.

8. What does this mean? • There is a policeman in an unmarked car going up and down highway 78 handing out tickets.

9. 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

10. 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

11. 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

12. 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

13. 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 care

14. Confirming Understanding • Ask patients to acknowledge understanding using their own words. 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?”

15. 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?”

16. 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.

17. Closing the Loop

18. 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.

19. 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.

20. 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 supine

21. 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 down

22. 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.

23. 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?

24. 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

25. 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.

26. 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.

27. 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

28. 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?”

29. 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

30. Practice Teach Back