Transcript Teach Back: Engaging Patients and Evaluating Learning

Teach Back
Engaging Patients and Evaluating Learning
©2014 MFMER | slide-1
Learning Objectives
Define Teach Back
Discuss how Teach Back can improve patient
understanding of discharge instructions and
help prevent hospital readmissions
List appropriate questions used to elicit a
patient’s Teach Back
List four essential principles of Teach Back.
Practice using Teach Back skills in a role play
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Why Teach Back?
 Helps to reduce 30 day hospital readmissions
 Common causes for readmission:
 Lack of patient/family involvement and
accountability in their own health care
 Patients/families do not fully understand how
to care for themselves at home
Reference: A. Boutwell and S. Hwu, Effective Interventions to Reduce Rehospitalizations: A Survey of the Published
Evidence (Cambridge, Mass.: Institute for Healthcare Improvement, 2009), p. 14.
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• Teach Back is a way to evaluate our delivery of
patient education in a way that continues to
engage the patient and family
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Why Traditional Teaching Methods Fall
Short
• Providers give too much information
• “need to know”
• Patient may not have been involved in the
development of the plan
• Patients may not realize the importance of
education at the time it is given
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• Patients may not understand the information
provided (Low health literacy)
• The stress of hospitalization and/or the patient’s
diagnosis limits their ability to concentrate and
understand
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Principles Of Adult Learning
• Addresses individual’s immediate need
• “Burning question”
• Centered on the person & their concerns
• Relate content to existing knowledge &
experiences
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Adult Learning Principles
• Active participation in varied learning activities
• Collaborative process, educator acts as the
facilitator
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People Remember:
10 % of what they read
20% of what they hear
30% of what they see
50 % of what they hear and see
70% of what they say or write
90% of what they do
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Patient Education and Motivational
Interviewing
• MI = Collaborative conversation about change
• Engages and focuses the patient
• Evocative: calls forth person’s own motivation
and commitment for behavior change
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Teach Back and MI
• Elicit – Provide - Elicit
• Check – Chunk - Check
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People are generally better persuaded
by the reasons for which they have
themselves discovered than by those
which have come into the mind of
others. Blaise Pascal
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“I told my patient
exactly what he
should do…..”
“Any questions?
Ok, good!”
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“
Do you
understand?
Do you have any
questions?
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What is Teach Back?
The patient discusses and/or demonstrates key
messages. Allows evaluation and affirmation of
their understanding.
◦ Accountability for patient learning is on the teacher
◦ Respectful and non-shaming
◦ Engages patients by asking them to state in their
own words what they understand
◦ Ideally the patient applies the information to their
unique situation
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Teach-back
Explain
Assess
Clarify
Understanding
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Starting the Teach Back Conversation
“I want to make sure
I explained that
clearly….”
“I want to be sure you
and your wife feel
comfortable with your
plan for going home…”
“Let’s make sure I did a
good job of going over
this information”
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Continue the Conversation with Good
Questions
“Would you
mind repeating
back to me
what you heard
me say?”
“Would you talk
through your daily
plan for taking your
medications?”
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Evaluate the Learning
• If learner/patient can Teach Back key messages
or topics, teaching has been successful
• If patient cannot Teach Back, review content
with a different approach
• Ask the patient to Teach Back again, using his
or her own words, until you are comfortable the
patient understands
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Effective use of Teach Back
• Make sure you’re teaching the right person
• Teach just a few main points, then stop and use
Teach Back to check understanding: Chunk,
Check
• Use it whenever you teach, on any topic
• Avoid doing all teaching in one session as
the patient is walking out the door
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Teach Back
• Prioritize what you will teach
• Stick to “need to know” information
• Use Teach Back throughout the patient’s
hospitalization
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Teach Back & Mental Health
• Assumptions
• Readiness to learn
• Evaluate patient’s understanding
Mental
Health
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Improving Patient Outcomes
• Build rapport
• Improve compliance
• Delivery of education
• Group
• 1:1
• Relevance to individual patient
Mental
Health
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Connecting With Your Patient
• Connect education to recovery
• Accommodate for individual needs
• How they learn (lecture, seeing, doing, etc.)
• What are their resources?
• Appraise for optimal times
•
•
•
•
•
•
Immediately after new information/skill is provided
New diagnosis
Change in plan of care
Intervention, medication changes
Discharge plan
Mental
Patient’s mood, readiness
Health
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Utilize Tools
• Tools
• Crisis plan
• Relapse prevention plan
• Discharge medication list
• Teach Back should be utilized throughout the
hospital stay - before day of discharge
Mental
Health
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Essential Themes
• Key messages
• Keep it simple
• Applicable to patient’s life outside hospital
Mental
Health
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Utilize Exploring Questions
What does your
diagnosis mean
to you?
What things do you
absolutely have to
take care of in the
first few hours of
going home.
Mental
Health
What is
waiting for you
when you get
home?
Describe those
things you can do
to take care of
yourself.
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Documentation of Teach Back
• Communicating & collaborating the key
message
• Document the outcome of patient education,
including ability to Teach Back, according to
your organizational guidelines
• Electronic Medical Record (EMR) may be
tailored to support documentation of Teach
Back for specific discharge education
• Documentation is important to reflect your
practice and support quality improvement
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Role Play - Scenarios
• Self care
• Skills to soothe
• Time management
• Relaxation therapy
• Medications
• Follow up appointments
•
•
•
•
Therapist
Psychiatrist
Primary care
Support groups
Mental
Health
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Teach Back: Elements of Competence
• Accountability is on the provider
• Use a caring voice and attitude
Mental
Health
• Use plain language
• Ask the patient to explain using his/her own
words
• Use Teach Back for all key points or “need to
know” patient education, specific to his or her
condition and life values
• Document the use of Teach Back (Able to Teach
Back)
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Role Playing
• What phrase did your “provider” use to start
Teach Back?
• How was the patient asked to tell what he/she
learned?
• How was this patient a part of making his/her
own plan for his/her own care?
Mental
Health
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Wrap Up Role Playing
• Do you feel certain this patient learned well
from the teaching? How do you know?
• How were key messages identified by the
“provider”
• Were these messages important to the patient?
Mental
Health
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• Take Aways?
• Surprises?
• Challenges?
Mental
Health
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Scenario I
Treatment Resistant Depression
• Scenario: A 65 year old male with recurring depression.
He’s been hospitalized three times in two years and
twice in the past four months. Since his retirement
three years ago he has struggled with symptoms of
depression. His wife was recently diagnosed with renal
failure and started dialysis. While hospitalized he has
participated in education groups, including distress
tolerance skills, developing a crisis plan, and discharge
planning.
• Instructions: Choose a topic to educate the patient (i.e. selfcare, medications, or follow up appointments). After
completing the patient education, evaluate his understanding
by asking questions and/or having him demonstrate skills.
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Scenario II
Personality Disorder – Self Injurious Behavior
• Scenario: A 22 year male with a history of physical abuse by
his father. As a teenager he was hospitalized multiple times
related to cutting. He is a full time student, and for several
weeks he has increasingly become isolative, skipping class,
experiencing thoughts of ending his life, and cutting on his
thighs. A concerned friend brought him to the emergency
department, he was subsequently admitted to the acute
psychiatric unit for safety. The patient’s medications have
been adjusted, his mood stabilized, he is contracting for
safety, and the psychiatrist is planning to discharge him in a
couple of days.
• Instructions: Choose a topic to educate the patient (i.e. selfcare, medications, or follow up appointments). After
completing the patient education, evaluate his understanding
by asking questions and/or having him demonstrate skills.
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Scenario III
• Anxiety
• Scenario: A 40 year old female was admitted with
increased anxiety. Recently she separated from her
significant other and is experiencing difficulties at work.
Initially she was unable to concentrate, making it difficult to
attend groups. For the past week she has attended and
participated in a variety of education groups, including
distress tolerance skills, relaxation therapy, sleep hygiene,
self-esteem, healthy lifestyles, survival skills, crisis planning,
and discharge planning.
• Instructions: Choose a topic to educate the patient (i.e. selfcare, medications, or follow up appointments). After
completing the patient education, evaluate her understanding
by asking questions and/or having her demonstrate skills.
•
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Scenario IV
• Suicide Ideation
• Scenario: A 34 year old female was hospitalized 7 days ago
after overdosing on her antidepressant and drinking
excessive amounts of alcohol. After failing to show up for
work, a co-worker found her unconscious in her apartment.
After 3 days in the ICU, she was transferred to the inpatient
psychiatry unit. Despite leaving a suicide note to her
boyfriend, she denies the attempt to end her life. The
primary psychiatric team is ready to discharge her from acute
care and notes that her medications were prescribed by a
primary care provider. In addition to primary care, follow up
appointments will include a psychiatrist and therapist.
• Instructions: Choose a topic to educate the patient (i.e. selfcare, medications, or follow up appointments). After
completing the patient education, evaluate her understanding
by asking questions and/or having her demonstrate skills.
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