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T EACH B ACK I MPROVING P ATIENT S AFETY AND E NGAGEMENT October 23, 2019 GPQIN Staff Jennifer Geisert Kathleen Panas Sally May Lisa Thorp RN, BSN MPH RN, BSN, CH GCN RN, BSN, CDE Quality Improvement Advisor Quality Improvement Senior

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TEACH‐BACK

IMPROVING PATIENT SAFETY

AND ENGAGEMENT

October 23, 2019

GPQIN Staff

Jennifer Geisert RN, BSN

Quality Improvement Advisor

Kathleen Panas MPH

Quality Improvement Consultant

Sally May RN, BSN, CH‐GCN

Senior Quality Improvement Specialist

Lisa Thorp RN, BSN, CDE

Quality Improvement Specialist Nebraska Kansas North Dakota North Dakota

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WELCOME AND REMINDERS

  • Use chat for questions and comments
  • Slides and recording will be available on the

GPQIN website in 7‐10 days

  • http://greatplainsqin.org

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FRAMING THE DISCUSSION

Objectives:

  • 1. Define teach‐back and role in improving patient safety and

engagement. What is teach‐back? Why use teach‐back?

  • 2. Practice the use of plain language.

What is plain language?

  • 3. Review the ten key elements of teach‐back.

How do we use teach‐back?

  • 4. Evaluate use of Teach‐back using Teach‐Back Observation Tool.

How do we implement teach‐back? What about training? What teach‐back resources are available?

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CEU FOR NURSES: 1.0 CONTACT HOURS

For individual attendees:

  • You will be redirected to the required evaluation when you

close out of this webinar

  • Certificate will be emailed in 3‐5 business days to individuals

completing the evaluation

For multiple attendees:

  • An email with a link to the required evaluation and

instructions to forward the email to fellow attendees will be sent to all individuals who logged into this webinar

  • Certificate will be emailed in 3‐5 business days to individuals

completing the evaluation [email address is required]

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TEACH‐BACK: WHAT IT IS

  • A evidence‐based health literacy

intervention that improves

  • Patient engagement
  • Patient safety
  • Adherence
  • Quality
  • Ask patients or family members

to explain in their own words what they need to know or do, i.e., teach‐back

  • A way to confirm that you clearly

explained information

  • A way to check for understanding

https://www.ahrq.gov/professionals/quality‐ patient‐safety/patient‐family‐ engagement/pfeprimarycare/teachback.html

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‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ease knowledge and sk self efficacy and self management To increase adhere effectiveness of To enhance self es decision making capa satisfaction with duce psyc ress and anxie physical morbidity risk of mortality

  • ve quality

TEACH‐BACK: WHAT IT IS

“Preparing an explanation using plain language before the interview, asking open‐ ended questions, ensuring that the teach‐back is encouraging and comfortable for the patient.” Nursing Student

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TEACH‐BACK: WHY USE IT

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We pursue patient education in order . . . To increase knowledge and skills To increase self efficacy and self management To increase adherence to and effectiveness of therapy To enhance self esteem, decision making capacity, and satisfaction with care To reduce psychosocial stress and anxiety To reduce physical morbidity and risk of mortality To improve quality of life

Feudtner, C. What are the goals of patient education. West J Med. 2001 Mar; 174(3):173‐174.

TEACH‐BACK: WHY USE IT

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We pursue patient education in order . . . To incr ills To increase nce to and therapy teem, city, and care To re hosocial st ty To reduce and To impr

  • f life

Feudtner, C. What are the goals of patient education. West J Med. 2001 Mar; 174(3):173‐174.

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SLIDE 4

You have what is called blah blah blah blah blah. Does he realize how long it has been since I studied anatomy and physiology of the eye?

THE TYPICAL PATIENT EXPERIENCE

You‘re a nurse – you don’t have any questions.

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TEACH‐BACK: WHY USE IT

Did you know . . .

  • Only 12% of literate Americans

are proficient in understanding health information1

  • Patients forget up to 80% of

what is told them at a clinic visit2

  • If they do remember, only half
  • f what they remember is

correct3

1. Minnesota Partnership for Health Literacy 2. Kessels RP. Patients’ memory for medical information. J R Soc Med 2003;96(5):219-22. 3. Anderson JL, Dodman S, Kopelman M, et al. Patient information recall in a rheumatology clinic. Rheumatology 1979;18(1):18-22.

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TEACH‐BACK: WHY USE IT

  • Confirm that your patients

have a clear understanding

  • f your description or

instructions

  • Prevent misunderstandings

that would affect adherence to the treatment plan or medication regimen

  • Minimize post visit clarifying

phone calls and emails

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TEACH‐BACK: WHY USE IT

The problem with communication is the illusion that it has occurred.

George Bernard Shaw

July 26, 1856 – November 2, 1950

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WHAT IS PLAIN LANGUAGE?

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Using plain language

A communication is in plain language if its wording, structure, and design are so clear that the intended audience can easily find what they need, understand what they find, and use that information. Source: International Plain Language Federation

PRACTICE: PLAIN LANGUAGE

Martha’s husband has heart

  • failure. Recently, a friend told

her that because of his heart failure he should not have any

  • salt. One day in the clinic she

asked you for information about “salt.” You give her the FDA Sodium Food Label brochure, the patient education brochure your

  • rganization uses . . .

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The better choice?

PRACTICE: PLAIN LANGUAGE

  • The opening paragraph . . .

The words “salt” and “sodium” are often used interchangeably, but they do not mean the same

  • thing. Sodium is a mineral and one of the chemical

elements found in salt. Salt (also known by its chemical name, sodium chloride) is a crystal‐like compound that is abundant in nature and is used to flavor and preserve food. Helpful?

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PRACTICE: PLAIN LANGUAGE

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QUE

UESTION:

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TEACH‐BACK: HOW TO USE IT

Using plain language

Guide to Improving Patient Safety in Primary Care Settings by Engaging Patients and

  • Families. Content last reviewed

May 2018. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/profession als/quality‐patient‐ safety/patient‐family‐ engagement/pfeprimarycare/tea chback.html

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Hand out

Responsibility is on the healthcare professional

  • 1. Use a caring tone of voice

and attitude

  • 2. Display comfortable body

language and make eye contact

  • 3. Use plain language not

medical terminology

“The doctor has changed how much medicine you should

10 Elements of Competence for

take and that can be

Using Teach‐back Effectively

confusing . . .”

http://www.teachbacktraining.org/assets/files/PDFS/Teach% 20Back%20%2010%20Elements%20of%20Competence.pdf

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Hand out

  • 4. Ask the patient to explain

back using their own words “Tell me what you will do when you get home.”

  • 5. Use non‐shaming, open‐

ended questions “Because you have several new pills, what will you do if you forget to take them one morning?”

http://www.teachbacktraining.org/assets/files/PDFS/Teach% 20Back%20%2010%20Elements%20of%20Competence.pdf 10 Elements of Competence for Using Teach‐back Effectively

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Hand out

  • 6. Avoid asking questions that can be

answered with a simple yes or no. “Do you know how to use your inhaler?”

  • 7. If the patient is not able to teach‐

back correctly, explain again and re‐ check

  • 8. Emphasize that the responsibility to

explain clearly is on you “You have had a busy appointment today and I want to make sure that my explanation of your medication changes was clear. What are some signs you need to watch for due to the changes in your medications?”

http://www.teachbacktraining.org/assets/files/PDFS/Teach% 20Back%20%2010%20Elements%20of%20Competence.pdf 10 Elements of Competence for Using Teach‐back Effectively

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Hand out

  • 9. Use reader‐friendly print

materials to support learning

  • 10. Document use of and patient

response to teach‐back

10 Elements of Competence for Using Teach‐back Effectively http://www.teachbacktraining.org/assets/files/PDFS/Teach% 20Back%20%2010%20Elements%20of%20Competence.pdf

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Teach‐Back Demonstration

Julie has just been told that she has hypertension. She wants to know what that

  • means. . . .

Audience participation: Enter into chat the various elements of teach‐back that you observe using the 10 Elements of Competence for Using Teach‐back Effectively handout.

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TEACH‐BACK: WHEN TO USE IT

  • A new diagnosis
  • Medication need and

proper use

  • Home care instructions
  • Recommended behavior

changes

  • Treatment options
  • Treatment plan
  • Use of a new device
  • Next steps

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TEACH‐BACK: HOW IS IT IMPLEMENTED?

Guide to Improving Patient Safety in Primary Care Settings by Engaging Patients and Families includes:

  • Implementation guide
  • Teach‐back tips (job aid)
  • Slides
  • Role play scenarios
  • Interactive module

Guide to Improving Patient Safety in Primary Care Settings by Engaging Patients and

  • Families. Content last reviewed May 2018. Agency for Healthcare Research and Quality,

Rockville, MD. http://www.ahrq.gov/professionals/quality‐patient‐safety/patient‐family‐ engagement/pfeprimarycare/teachback.html

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TEACH‐BACK: HOW IS IT IMPLEMENTED?

  • Review intervention and

training materials

  • Implementation decisions
  • Scope
  • Workflow: Documentation
  • Champion
  • Customize training
  • Train team members
  • Pre‐work: Interactive module

(20‐30 min)

  • Teach‐back Clinic (20‐30 min)*

*30‐45 min if plain language exercise included

  • Go live

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TEACH‐BACK: HOW IS IT IMPLEMENTED?

date and time of completion documented

http://www.teachbacktraining.org

TEACH‐BACK: HOW IS IT EVALUATED?

Always Use Teach-back! Includes:

  • Online interactive Teach-back

Module

  • Couching videos for nurses and

physicians

  • Teach-back implementation

guide

  • Evaluation tools
  • Confidence and Conviction

Scale – Prior, 1, 3, 12 months

  • Teach-back Observation

Tool – Initially and annually

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TEACH‐BACK: WHAT RESOURCES ARE AVAILABLE?

Great Plains Quality Innovation Network Includes:

  • Teach-back planning

guide

  • PowerPoint presentation

with speaker notes

  • Agenda, evaluation

forms, and attendance logs

http://greatplainsqin.org/initiatives/coordination-care/teach-back-training/

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TEACH‐BACK: HOW IS IT EVALUATED?

  • Phone calls with follow‐up questions pre‐ and post‐

implementation

  • Missed appointments, i.e., “no shows”
  • Patient outcomes pre‐ and post‐ implementation
  • HbA1C, blood pressure, immunizations . . .
  • Medication regime adherence
  • Acute care utilization, i.e., ED, observation stays, inpatient

hospitalizations

  • Patient satisfaction with staff and provider

communication

  • Staff satisfaction with teach‐back
  • Use of teach‐back, i.e., documentation

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TEACH‐BACK: THE ‘TAKE AWAY’

Medication Reconciliation Information Reconciliation

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CEU FOR NURSES: 1.0 CONTACT HOURS

For individual attendees:

  • You will be redirected to the required evaluation when you

close out of this webinar

  • Certificate will be emailed in 3‐5 business days to individuals

completing the evaluation

For multiple attendees:

  • An email with a link to the required evaluation and

instructions to forward the email to fellow attendees will be sent to all individuals who logged into this webinar

  • Certificate will be emailed in 3‐5 business days to individuals

completing the evaluation [email address is required]

33

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Upcoming Event

Don’t Miss the Follow‐Up Coaching Call Teach‐Back: Implementation and Training November 6, 2018 12:15 ‐ 12:45 pm (CT) The WebEx will provide practical and specific strategies to incorporate teach‐back in the workflow at your clinic, measure effectiveness of teach‐back implementation, and provide teach‐back training to staff. A brief review of teach‐back implementation and training will be followed by a question and answer session. We will send the call in information and details for participation after today’s WebEx.

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How to Get Involved

Contact Information

Sally May sally.may@area‐a.hcqis.org 41 36th Ave NW Minot, ND 58703 P: 701.989.6228 Great Plains Quality Innovation Network http://greatplainsqin.org/

This material was prepared by the Great Plains Quality Innovation Network, the Medicare Quality Innovation Network‐Quality Improvement Organization for Kansas, Nebraska, North Dakota and South Dakota, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 11SOW‐GPQIN‐ND‐C3‐201/0718

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