Implementing teach-back using improvement methodology 11 th March 2013

1. Implementing teach-back using improvement methodology 11th March 2013 Julie Adams Senior Programme Manager, NSD

2. Wave 18

4. The Project!

5. My project

6. Specialist Clinic Evolution of the aim: Inhaler technique Discrepancies between hospital and community pharmacy systems Preventative Care / Acute Management Children not taking the prescribed dosage (compliance) for their inhalers – preventable hospital admissions Health literacy issues Medicines reconciliation Re-admissions

7. Child’s Care Pathway

8. Baseline data

9. Baseline data Sample from Respiratory Clinic Attendees (Jan-March 2011) - healthcare professional who delivered initial inhaler technique training

10. Multi-dose technique in NHS Lanarkshire One Puff Ten Breaths 30 seconds between ‘puffs’

11. Children not taking the prescribed dosage (compliance) for their inhalers – preventable hospital admissions Evolution of the aim: Outcome Aim: Increase asthma medication self management for children admitted to Wishaw General Hospital paediatric ward, with asthma or viral wheeze by July 2011. What are we trying to accomplish? Improve self-management processes linked to asthma medication during an acute inpatient admission, by June 2011. Teach-Back Technique Children discharged - using correct inhaler technique Staff Education Inhaler Technique Medicines Reconciliation Children discharged - using correct inhaler dosage Use own inhaler medication Measure of Compliance

12. Self-management of asthma medication 95% of all children will receive asthma inhaler technique training prior to discharge. % of children with own inhaler on ward Children bring their asthma medication into hospital within 24 hrs of admission Increase asthma medication self management for children admitted to Wishaw General Hospital paediatric ward, with asthma or viral wheeze by July 2011. Asthma medication – medicines management processes Asthma medication reconciled within 24 hours of admission Asthma medication reconciled prior to discharge % of inhaler medication reconciled on admission Inhaler technique training Self-management Ward staff delivering asthma self-management education % of staff trained to deliver asthma inhaler technique training Inhaler technique training highlighted at nurse handovers, safety briefings and multi-disciplinary ward rounds. Children/parents involved in discharge medicines reconciliation Discharge processes Asthma discharge checklist compliance % of self-management education delivered by ward staff ward Standardised discharge self-management education Measures

13. When you feel wheezy - what will you tell your mum, dad or teacher should happen? Developing teach-back tools & trainingMethods to check understanding....... Please show me how you use the asthma inhaler? ‘We discussed a lot today. Can you tell me what you found most important about your child’s condition?’

14. Measures……

15. NHS Lanarkshire / IA – Asthma Inhaler Project Implementation of Teach-back training

16. Measures…… Plateau of training

17. Outcomes – medicines reconciliation

18. Outcomes – inhaler technique

19. Results….. Data collection issues – within 24 hrs / prior to discharge

20. Asthma Inhaler Project – Data Collection: Outpatient Clinic assess new referrals knowledge of multi-dose technique Clinic: _________________________ Asthma Inhaler Project – Data Collection: Outpatient Clinic assess new referrals knowledge of multi-dose technique Clinic: _________________________ Asthma Inhaler Project – Data Collection: Outpatient Clinic assess new referrals knowledge of multi-dose technique Clinic: _________________________

21. Achievements so far….. • Implementation of system of reviewing asthma multi-dose inhaler technique - using teach-back. • The Respiratory Clinic: • increase in no. children demonstrating correct inhaler technique (after hospital admission); • reduction in need for specialist education. • Conclusion: • benefits of teach-back demonstrated. • Next Stage: • monitor readmissions; • engage with primary care clinicians to support inhaler technique education within primary care.

22. Leader Ingredients for successful project:IA skills: motivate infuse teacher mentor imagination teamwork success

23. Any Questions?