Transcript Document

Teach Me, Show MeWhat’s Teach-Back All About ?
April 29, 2015
Gale Billingsley
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Program Objectives
The Rationale for the teach-back method
Define teach- back
Describe the key elements for using teach-back
Impact of teach-back in the hospital setting
Health Literacy
“The degree to which individuals have the capacity to
obtain, process and understand basic health information
and services needed to make appropriate health
decisions .”
Health People 2010
“Health Literacy is more than a measurement of reading
skills, it also includes writing, listening, speaking,
cultural and conceptual knowledge.”
IOM ,2004
Low Health Literacy and Patient Safety
40-80% of medical information patients receive is forgotten
immediately and nearly half of the retained information is
incorrect (AHRQ, 2010)
• Ninety-eight percent of medical errors are communicationrelated (AMA, 2007)
• Nearly half of all adult Americans -90 million people- have
difficulty understanding & using health information due to
low health literacy (IOM, 2004)
• Patients with limited literacy say they feel shame and hide
their limited reading ability from others (Parikh,1996;
Wolf,2007
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How Patients Feel
• Patients may have negative feelings and emotions
related to their limited reading ability or limited
understanding.
Institute of Medicine, 2004
•The health care environment can make it difficult
for patients to tell us they don’t read well or do not
understand
• Patients hide their lack of health literacy with a
variety of coping techniques
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Health Literacy Skill Set
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Basic reading skills
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Ability to understand oral communication
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Ability to use numbers and math skills
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Basic understanding of how to navigate the health
system
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Ability to communicate with health care providers
and their staff.
Recommendations for Addressing Health
Literacy Concerns
 Use evidence-based models of communication health-related
information and skills to people with low health literacy
 Improve health literacy awareness ,knowledge and skills
among professions in the health care arenas
 Identify strategies to better communicate health education
messages to people with low health literacy.
Adapted from : North Carolina Institute of Medicine Health Literacy
Task Force, 2007.
Universal Communication Principles
•Everyone benefits from clear information
•Many patients are at risk of misunderstanding, but it is
difficult to identify them
•Testing general reading levels does not ensure patient
understanding in the clinical setting
Adapted form : “Reducing the Risk by Designing a
Safer,Shame-Free Health Care Environment. AMA, 2007
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The Right to Understand
• Patients have the right to understand healthcare
information that is necessary for them to safely care for
themselves ,and to choose among available alternatives
• Health care providers have a duty to provide information in
simple, clear and plain language and to check that patients
have understood the information before ending the
conversation.
The 2005 White House Conference on Health Literacy and Health
Disparities.
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“Self-Management and Health Literacy
Are Two Sides of A Coin.”
Joanne G. Schwartzberg, MD, Director of the Program on Aging and Community
Health at the American Medical Association (AMA) in Chicago.
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Teach-Back
• What Is It ?
• Why Do I Use It ?
• How Do I Use It?
• When Do I Use It?
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Teach- Back:
A Health Literacy Tool To Ensure
Patient Understanding
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What is the Teach Back Technique
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Teach Back is a communication technique used to help
patients remember and understand the important
information regarding their diagnosis ,treatment or
medication.
Also known as the “show-me” method or “closing the
loop.”
Closes the communication gap between clinician and
patient.
Involves asking patients to recall and then explain or
demonstrate the important information discussed during
an interaction with the health care team.
Why is Teach-Back Important
Only 12% of adults,in general, have proficient health
literacy.
Almost 9 out of 10 adults may lack the skills needed to
manage their health to prevent disease
Patients frequently leave the health care setting without
understanding what they need to do to follow medical
recommendations.
Health Literacy Basics. US Department of Health & Human Services Office of Disease
Prevention & Health
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Factors that Cause Misunderstanding
Provider Factors
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Difficulty simplifying
complex or confusing medical terms or concepts
Limited time for discussion
Having to communicate a lot of information at once
Overestimating the patient’s understanding of information
Patient Factors
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Lack of understanding of medical terms/jargon
Older age and possible cognitive decline
Language barriers
Feeling overwhelmed by information or emotion
Lack of focus caused by illness
Medication affecting memory or cognition
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Teach Back Is …
A research –based health literacy intervention that improves patient-
provider communication and patient health outcomes
(Schillinger, 2003)
Combines educational and communication theories to
-Transfer knowledge and skill from provider to patient
-Enhance patient understanding and integration of
health related information and behaviors
- Goal is patient competency in management of self
care.
Recommended as a top patient safety practice by the National Quality
Forum (NQF)
Teach-back is Supported by Research
•“Asking that patients recall and restate what they have been told “
is one of the top patient safety practices based on the strength of
scientific evidence :
AHRQ, 2001 Report, Making Health Care Safer
•“Physicians’ application of interactive communication to assess
recall or comprehension was associated with better glycemic
control for diabetic patients.”
Schillinger, Arch Internal Medicine/Vol 163, Jan 13,2003, “Closing
the Loop.”
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“Despite recent research showing that many
benefits of teach-back, based on market research,
few providers actually use it every day.
This may be because clinicians may not be
familiar with the teach-back method or may find it
difficult to change their Communication Style”
Joanne G. Schwartzberg, MD
Teach-back is…
•Asking patients to repeat in their own words what
they need to know or do, in a non-shaming way
•Not a test of the patient, but of how well you
explained the concept
•A chance to check for understanding and, if
necessary to reteach the information
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Using Teach Back
• Assures you – the health care provider-explained
information clearly. It is not a test of patients .
• Involves asking a patient or patient care giver (PCG) to
repeat back information shared, in order to assess
additional needs and close communication gaps
• Offers the opportunity to re-explain ,in a different way, and
assess again until patient understanding is confirmed.
Asking for a Teach-back
Ask patients to demonstrate understanding , using their own words:
•“I want to be sure I explained everything clearly. Can you explain it
back to me so I can be sure I did?”
• “What will you tell your husband about the changes we 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/
tell me what we talked about.
How will you make it work at home ?”
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Teach-Back
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Creates an opportunity for dialogue in which the provider gives
information, then ask the patient to respond and confirm
understanding before adding any new information
• Re-phrase if a patient is not able to repeat the information accurately
• Ask the patient to teach back the information again, using their own
words, until you are comfortable they really understand it.
• If the patient still does not understand, consider other strategies.
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TEACH -BACK :
A HealthLiteracy Tool to Ensure Patient
Understanding
10 Elements of Competency
Use a caring tone of voice and attitude
Display comfortable body language and make eye contact
Use plain language
Ask the patient to explain back, using their own words
Use non-shaming, open-ended questions
Avoid asking questions that can be answered with a simple yes or no.
Emphasize that the responsibility to explain clearly is on you, the provider or
health care professional
If the patient is not able to teach back correctly, explain again and recheck
Use reader –friendly print materials to support learning.
Document use of and patient response to teach-back
Examples of Plain Language
INSTEAD OF
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Hypertension
Modify
Respiratory
Oral
Ambulate
Optimal
Negative
Diet
TRY SAYING
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High Blood pressure
Change
Breathing
By mouth
Walk
Best way
“Good” or “bad” result
What you eat
When Using Teach-back, Be Sure To:
• “Chunk and check”-repeat for understanding for next important concept
before moving on to the next
• Re-phrase ,rather than repeat, information patient does not understand
• Continue use of Teach Back until you are comfortable the patient
understands.
• Include information on how to integrate new skills into lifestyle
• If the patient is not able to teach back after several times, consider other
strategies: pcg ; pictures /icons ; take a break or ask another member of
the team to explain.
Non-shaming Assessment of
Understanding
• “ I want to be sure I did a good job explaining everything
clearly. Can you explain back to me so I can be sure I did?”
• “What will you tell your wife about the changes we made to
your medicine today?”
• “We’ve gone over a lot of information. In your own words
,please review with me what we talked about.”
Teach-back- Additional Points
•Avoid asking yes/no questions like :
“Do you understand?”
“Do you have any questions?”
•For more than one concept:
Teach the 2-3 main points for the first concept &
check for understanding using teach back…
Then go to the next concept
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Use Health Education Material to Support Teachback
• Use in Conjunction with Spoken Instruction
• Help facilitate discussion
• Focus on a specific point of care that needs further reinforcement
• Review the material with the patient
• Make note of important information by circling or highlighting it
in the material. Consider personalizing the material by adding the
patient’s name ,medications or specific care instructions
• Repeat & Follow up:
** Provide follow up phone contact and refer to the educational material
again in future visits.
** If needed give the material to the patient more than once & focus on
different topics at subsequent visits.
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HCAHPS
HCAHPS-
Hospital
Consumer
Assessment
Healthcare
Providers
Systems
•Standardized survey instrument & data collection tool to
measure patient’s perspective on hospital care
•Administered to a random sample of patients
continuously throughout the year
•CMS cleans, adjusts and analyzes the data, then publicly
reports the results
Hospital level results are publicly reported on the Hospital Compare website 4 times a year.
HCA
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HCAPS survey is 32 questions in length.
Composite topics
•Nurse communication (questions 1,2.3)
•Doctor communication (questions 5,6,7)
•Responsiveness of hospital staff (questions 4,11)
•Pain management (questions 13,14)
•Communication about medicine (questions 16,17)
•Discharge information (questions 19,20)
Individual topics
• Cleanliness of hospital environment (question 8)
• Quietness of hospital environment (question 9)
Global topics
•Overall rating of hospital (question 21)
•Willingness to recommend hospital (question 22)
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Talking with Patients & Families at Discharge
ALWAYS:
• Use Plain Language
• Slow Down
• Break the information down into short statements
• Focus on the 2 or 3 most important concepts
• Check for understanding using teach-back
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References
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Can Teach –Back Reduce Hospital Admissions;
Melanie Haney, BSN,RN,PCCN, and Jessica
Shepard,BSN,RN. American Nurse Today. Volume
9, Number 3 pp 50-51.

The Relationship Between Hospital Patients’
Ratings of Quality of Care and Communication.
Anita Keller et al. Internal Journal for Quality
Care 2014; Volume 26,Number 1:pp. 26-33
References
Quality of Discharge Practices and Patient
Understanding at an Academic Medical Center,Leora I.
Horwitz, M.D et al; JAMA Internal Medicine; 2013.9318
Is Teach-Back Associated with Knowledge Retention
and Hospital Readmission in Hospitalized Heart
Failure Patients? Matthew White,RN,NP et al; Journal
of Cardiovascular Nursing, DOI:10 1097/JCN
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Teach-Back: “What’s In It for Me ?"
•Improved Patient Self Management & Patient Engagement
•Patient Empowerment
•Patient Safety
•Reduced Hospital Admissions & Readmissions
•Reduced Clinician Burnout
•Improved Productivity & Efficiency in the clinical setting
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Teach-Back : Getting Started
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Questions to Consider
What are specific topics or directions you commonly discuss with your patients that you
can use the teach-back method with?
What can you & your colleagues do to commit to using the teach-back technique in your
patient setting
How can you better incorporate patient education materials into teach-back
How in your practice/hospital will you track & monitor the results from using teach-back
Educational Strategies Prior to Discharge
Prior to discharge, develop a diabetes education plan for each patient
1.They MUST know the TYPE of diabetes they have (Type I, Type II, Gest.)
2.They MUST know their updated HbA1c (within last 60 days) AND understand
it. Provide the eAG (estimated Average Glucose) value of their HbA1c. The
Conversion Table: HbA1c to eAG is in the unit Diabetes Resource Notebook.
3.They must understand monitoring and know home glucose level goals
4. They must know the definition, recognize, and understand treatment and
prevention of hypoglycemia ( the Rule of 15’s) as well as hyperglycemia
5.Prevention choices of other acute and chronic complications are good to
know
6.Identification of the healthcare provider who will provide diabetes care after
discharge must be made, AND an appointment set for f/u documented
BEFORE discharge with date and time and name of provider. This must be
documented in the “Follow up Provider” section of the After Visit Summary
7. Information: consistent eating patterns and dietary guidelines, ? refer to RD
8. When & how to take medication, with proper disposal of needles /lancets
9. Sick day management: Do they know when to call their provider?
10. Incorporating physical activity into lifestyle can reduce medication needs
11. Strategies for accomplishing psychosocial and behavioral goals- ? support
groups
*Based on ADA and AACE recommendations
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Tools/ Resources for Getting Started
• http://www.nchealthliteracy.org/toolkit/tool5.pdf
• http://www.ethics.va.gov/docs/infocus/INFocus_20060401_Teach_Back.pdf
• http://www.healthliteracy.com/article.asp?PageID=6714
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Patient Rights
It is neither just, nor fair , to expect a patient to
make appropriate health decisions and safely
manage his/her care without first understanding
the information needed to so.
Reducing the Risk of Designing a Safer , Shame –Free Health Care
Environment , AMA, 2007
TEACH -BACK :
A HealthLiteracy Tool to Ensure Patient
Understanding
TEACH -BACK :
A HealthLiteracy Tool to Ensure Patient
Understanding
Questions
Thank-You
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