Transcript Final Teach Back Posterx

Implementing Teach-Back in the Post Anesthesia Care Unit
Kathleen O’Sullivan, MSN, RN
University of San Francisco School of Nursing and Health Professions
Introduction
Methods
Barriers of Discharge Teaching
 With new advancements in healthcare, patients are now spending less
time in the hospital and more time practicing self-care at home
(Kornburger, Gibson, Sadowski, Maletta & Klingbeil, 2013)
 This reduction in time spent in the hospital brings a focused attention to
discharge planning patients receive by the nursing staff
 Teach-back has been shown to help reduce complications and
readmissions of patients
 Through asking open-ended questions and having the patients repeat
what discharge information has been taught, the nurse can assess how
effective the teaching was
 The teach-back method is also promoted as best practice by the Joint
Commission, Institute for Healthcare Improvement, and the Agency for
Healthcare Research and Quality (Mahramus, Penoyer, Frewin,
Chamberlain, Wilson, & Sole, 2014)
 The assessment of discharge planning was separated into three phases:
the pre-intervention phase, in-service phase, and post-intervention phase
 During the pre-intervention phase, 26 nurses were surveyed to assess
their current understanding of teach-back, time spent on discharge
planning, and how much time they need for effective discharge teaching
 25 patients were surveyed to assess their knowledge of their personal
discharge plan after the nurse had completed discharge teaching
 During the in-service phase, each nurse completed a one-on-one 15
minute educational sessions on the teach-back method
 The post-intervention surveys will assess the nurses’ use of teach-back
after the in-service education and the time spent on discharge planning
 25 patients will also be surveyed to determine if patient understanding
of discharge teaching has improved
Teach-Back Tips Provided to Staff
 Use non-shaming, open ended questions
 Ask the patient to explain back discharge plans, using their own words
 Use this time to fill in the gaps or clarify information
 Sample Questions:
 I want to make sure I have explained your medications
correctly, can you tell me what your medications are and
when you take them?
 Can you tell me how you are going to take care of your
bandages?
 What kinds of foods should you be eating?
 Language Barriers
 Willingness to learn/Disinterest
 Education Level
 No clear instruction from service
 Level of consciousness
 Time
 Level of understanding of medical terminology
 Family involvement
Patient Pre-Intervention Results
Patient Survey Results
Purpose
100.00%
Nursing Pre-Intervention Results
 Improved patient communication has been shown to help successfully
transition patients from the hospital to the community (Dantic, 2013)
 The American Medical Association has suggested that hospital
personnel use plain language and visual aids, keep focus on the most
important aspects of discharge teaching, and have the patients teachback what has been taught to ensure understanding (Jager & Wynia,
2012)
 Patient education should be completed in small blocks of time and
periodically checked for understanding (Kornburger et al., 2013)
90.00%
80.00%
70.00%
60.00%
How nurses feel about Teach-Back
14
50.00%
Yes
No
40.00%
12
30.00%
10
Post-Intervention
20.00%
10.00%
8
Familiarity with teach-back
6
How often teach-back is used
Goals of Teach-Back
0.00%
Can state medication purpose
and dosage
Can state proper self-care at
home
Can state when to call the
hospital
Can state when their follow-up
appointment is
4
 Promoting patient safety
 Decreased readmission rates
 Reducing complications experienced by patients
 Increased patient satisfaction
Analysis of Pre-Intervention Results
2
0
1
2
3
4
 Nurse understanding of the teach-back method was high, although not
many nurses were using the teach-back method during discharge
planning
 The biggest misconception of the teach-back method is that the primary
purpose is to test patient understanding when the true purpose is to
ensure the information is adequately presented
 Patients were retaining 68% of the information presented, with the
medications proving to be the most difficult to recall
5
Self ratings on scale of 1-5
Objective
What is the purpose of Teach-Back?
30
 To assess the effectiveness of current discharge teaching in the Post
Anesthesia Care Unit (PACU)
25
20
Root Cause Analysis
15
In-Service on the Teach-Back Method
10
5
0
Determine patient understanding
See how well information was presented
Reinforce information already given
How much time you have versus how much time you need for discharge planning
18
16
14
12
10
Required time for discharge
Actual time spent on discharge
8
6
4
2
0
1 thru 3
4 thru 7
Amount of time spent (minutes)
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www.PosterPresentations.com
8 or more
 In-service education focused on six discharge teaching points that are
important to all patients leaving the PACU
 Care of the dressing
 Activities
 What to eat
 Medications
 When to call the MD
 Follow-up appointments
 Nurses were also reminded to provide the information following these
guidelines
 Use eye contact if culturally appropriate
 Be at the patients level if possible
 Use Layman’s terms
 Use short, clear and direct phrases
 Assess the engagement of the patient
 Include family or caretaker in discharge teaching when
possible
 Post-intervention surveys of nurses and patients are currently being
conducted
 The teach-back tips provided to the nursing staff have been well
received and the staff feel their discharge teaching is more effective
 Currently, patient retention of discharge information has been greater
than the pre-intervention phase
 A nurse will also be trained in overseeing biannual audits to ensure
future staff compliance with the teach-back method
Nursing Relevance
 The teach-back method will help benefit the nursing profession by
providing nurses with the appropriate language for discharge teaching as
well as the right questions to ask patients
 Nurses will be able to determine which areas the patient lacks
understanding before the patient returns home
 Teach-back contributes to the nursing mission in the PACU, which is to
ensure a safe recovery from surgery
Recommendations
 More Clinical Nurse Leader (CNL) or nursing manager led in-services
to educate staff on discharge teaching
 Allow more time for staff to practice using the language of the teachback method to increase its effectiveness
References
 Dantic, D. (2014). A critical review of the effectiveness of ‘teach-back’ technique in teaching COPD patients self-management using respiratory
inhalers. Health Education Journal, 73(1), 41-50. doi:10.1177/0017896912469575
 Jager, A., & Wynia, M. (2012). Who gets a teach-back? Patient-reported incidence of experiencing a teach-back. Journal Of Health
Communication, 17294-302. doi:10.1080/10810730.2012.712624
 Kornburger, C., Gibson, C., Sadowski, S., Maletta, K., & Klingbeil, C. (2013). Using “Teach-Back” to Promote a Safe Transition From Hospital to Home:
An Evidence-Based Approach to Improving the Discharge Process. Journal Of Pediatric Nursing, 28(3), 282-291. doi:10.1016/j.pedn.2012.10.007
 Mahramus, T., Penoyer, D., Frewin, S., Chamberlain, L., Wilson, D., & Sole, M. (2014). Assessment of an educational intervention on nurses' knowledge
and retention of heart failure self-care principles and the Teach Back method. Heart & Lung, 43(3), 204-212. doi:10.1016/j.hrtlng.2013.11.012