Teach-Back: Make Sure they Understand

Kelly Pick MSN RN-BC NPD

Patient and Community Education

PeaceHealth Southwest Medical Center

Last Trip to that Store

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Who needs Teach-Back?

employee colleague

child

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Key Resources

AMA Health Literacy and Patient Safety: Help Patients

Understand. Manual for Clinicians, Weiss et al. (2007)

AHRQ Universal Precautions Toolkit, DeWalt, et al. (2010)

Always Use Teach-back! Training Toolkit, AMA, Picker Institute, UnityPoint Health, Des Moines University, et al. (2014) http://www.teachbacktraining.org/

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Health Literacy

Weiss, B.D. (2007) 5

…for Low Health Literacy

• Can’t tell by looking

• Communicate clearly with everyone

• Confirm understanding with everyone

Universal Precautions…

DeWalt, et al. (2010) AHRQ Universal Precautions Toolkit 6

Clear Communication

• Slow down

• Use plain, non-medical language

“living room language”

• Show or draw pictures

• Create a shame-free environment

• Use Teach-Back

Weiss, B. (2007) 7

Teach-Back: What is it?

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How does Teach-Back help? Health Care

• Patient safety• Patient engagement and

satisfaction• Reduces:

–unnecessary clinic visits–emergency room visits –hospital re-admissions

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Business/Government/Education• Provides clarity• Improves customer/constituent

satisfaction

Family and Friends• Better relationships

All: Quick and easy way to assess understanding

“I don’t have time”

Studies and Pilot Projects

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Start small:

• One patient encounter per day (last visit)

• Work up to more as you get more

comfortable

• Practice at home

Key Learner

Identify and involve as much as possible

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Need-to-know versus Nice-to-know

Needs Assessment

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A Physician’s Experience

www.teachbacktraining.org 13

Chunk ‘n Check

…if more than 2-3 points

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Knowledge: Can you tell me how much insulin you should give yourself every day?

Attitude: Do you know why it’s important foryou to take your Lasix every day?

Behavior: How do you plan to remember to take all your medicines correctly every day?

Three Types of Questions:

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Avoid yes/no questions

• Do you understand?

• Does that make sense?

• Is that clear?

Check for Understanding

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Take Responsibility…

I want to make sure you understand…

Whose fault is it?

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versus

I want to be sure I’ve been clear...

Repeat back

Avoid the Parrot

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versus

Teach back in your own words

What questions do you have?

You don’t have any questions, do you?

Effective Questioning

versus

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Teach-Back Reminder Card

Keep card with you to refer to for Teach-Back

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Demo and Practice

• Teach your partner how to use the call light

(less than a minute)

• Use Teach-Back card to remind you of the steps:

1. Teach concept

2. Take responsibility

3. Ask for Teach-Back in own words

4. Ask for questions

• Switch roles

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When Teach-Back isn’t used…

From House, M.D., Episode #511, Joy to the World, Fox Network 22

What questions do you have?

Kelly Pick MSN, RN-BC NPD

Patient and Community Health Education

PeaceHealth Southwest Medical Center

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References and Further Reading

5 Million Lives Campaign. (2008). Getting started kit: Improved care for patients with congestive heart failure how-to guide. Cambridge, MA: Institute for Healthcare Improvement. (Available at www.ihi.org)

The Advisory Board Company. (2011). Innovating on 'teach-back' to prevent avoidable readmissions. Retrieved from The Advisory Board Company.

Brach C., Dreyer, B., Schyve, P., Hernandez L.M., Baur, C., Lemerise, A. J., Parker, R. (2012). Ten attributes of health literate health care organizations. Institute of Medicine Roundtable on Health Literacy. Retrieved from: http://www.iom.edu/~/media/Files/Perspectives-Files/2012/Discussion-Papers/BPH_HLit_Attributes.pdf

Centers for Disease Control and Prevention (2009). Simply put: A guide for creating easy-to-understand materials. Third Edition. Atlanta, GA. Retrieved from http://stacks.cdc.gov/view/cdc/11938/

DeWalt D. A., Callahan, L.F., Hawk, V. H., Broucksou, K. A., Hink, A., Rudd, R., & Brach, C. (April 2010). Health Literacy Universal Precautions Toolkit. Rockville, MD: Agency for Healthcare Research and Quality. AHRQ Publication No. 10-0046-EF. Retrieved from http://www.ahrq.gov/qual/literacy/index.html

Fidyk, L., Ventura, K. & Green, K. (2014). Teaching nurses how to teach: Strategies to enhance the quality of patient education. Journal for Nurses in Professional Development, 30(5): 248-253.

Healthcare Benchmarks and Quality Improvement. (December, 2010). Readmission rates for HF reduced by 30%. Volume 17(12), p.137-138. Retrieved from http://www.henryfordconnect.com/documents/Sladen%20Library/HBQI-December2010.pdf

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In Focus: Topics in Health Care Ethics (April, 2006). Teach back: A tool for improving provider patient communication. National Center for Ethics in Health Care.

Institute for Healthcare Improvement (2008). Good heart failure care follows patients home. Cambridge, MA: Institute for Healthcare Improvement (Available at www.ihi.org).

Institute of Medicine (2004). Health literacy: A prescription to end confusion. Washington DC: The National Academies Press.

Kripalani, S., Bengtzen, R., Henderson, L.E., & Jacobson, T. A. (2008). Clinical research in low-literacy populations: Using Teach-Back to assess comprehension of informed consent and privacy information. IRB: Ethics and Human Research. March-April, pp.13-19.

Kutner, M., Greenberg, E., Jin, Y., & Paulsen, C. (2006). The Health Literacy of America’s Adults: Results From the 2003 National Assessment of Adult Literacy. U.S. Department of Education. Washington, DC: National

Center for Education Statistics. (NCES 2006–483)

London, F. (2009) No time to teach: The essence of patient and family education for health care providers. Atlanta, GA: Pritchett & Hull.

National Quality Forum (2010). Safe Practices for Better Healthcare – 2010 Update. Retrieved from http://www.qualityforum.org/Publications/2010/04/Safe_Practices_for_Better_Healthcare_%e2%80%9

3_2010_Update.aspx

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Osborne H. (2011). In other words...Confirming understanding with the Teach-Back Technique. Health Literacy Consulting. Retrieved from http://www.healthliteracy.com/article.asp?PageID=6714

Press, V., Arora, V., Shah, L., Lewis, S., Charbeneau, J., Naureckas, E., & Krishnan, J. (2012). Teaching the use of respiratory inhalers to hospitalized patients with asthma or COPD: A randomized trial. Journal of General Internal Medicine, 27(10), 1317-1325.

Sandberg, E., Sharma, R., & Sandberg, W. (2012). Deficits in retention for verbally presented medical information. Anesthesiology, 117(4), 772-779.

Schillinger, D., Piette, J., Grumbach, K., Wang, F., Wilson, C., Daher, C., … Bindman, A. B. (2003). Closing the loop: Physician communications with diabetic patients who have low health literacy. Archives of Internal Medicine; 163:83–90.

US Department of Health and Human Services. (2010). Health literacy. Retrieved from www.health.gov/communication/literacy/quickguide/factsbasic.htm

Weiss, B.D. (2007). Health literacy and patient safety: Help patients understand, manual for clinicians, Second edition, A Continuing Medical Education opportunity. Date of most recent activity review April 2009. Chicago, IL: American Medical Association Foundation and American Medical Association.

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