Download Teach-Back Method A Health Literacy Tool to Ensure Patient

MaineGeneral Medical Center
2012
Prepared by Sandra Neptune, RN, BSN & Susan McLeod, RN, BC
Clinical Practice and Professional Advancement

Cognitive: define teach-back and its purpose

Psycho-motor: demonstrate teach-back technique

on
your unit
Affective: realize the value of teach-back and
promote it
within your department
Increased awareness of & sensitivity to
Health Literacy can:
◦ Improve patient safety
◦ Enhance patient learning
◦ Increase appointment keeping
◦ Increase compliance with regimens
◦ Remove barriers to accessing care

Systems are increasingly complex

Workers use the language of their discipline

Words can be barriers to communication and
understanding
40 to 80% of the medical information
patients receive is forgotten immediately
Studies have shown that:
Nearly half of the
information patients retain
is incorrect
Let’s listen to some patients
to understand the problem
http://www.youtube.com/watch?v=7MoQTC-mxxM
TEACH-BACK
 Closes
the gap of
communication
 Enhances
patient safety

Confirms that you have
explained
◦ What patients need to know
◦ In a manner that patients
understand
Is confirmed when
they explain it
back to you
http://sp2.mainegeneral.org/SiteDirectory/CE/American%20H
eart%20Association%20programs/Forms/AllItems.aspx
ALWAYS:

Slow down

Use plain language
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Break information into short statements

Focus on the 2 or 3 most important concepts

Check for understanding using teach-back
This is not a test of the patient’s knowledge
but a test of
how well you explained the concept
Use this with Everyone
whether you think the
person understands or
not

Used to teach

EX: Injecting insulin
◦ Concepts
◦ Techniques
◦ Ask the patient to show you
 Preparation of insulin
 Injection of insulin
◦
Then address any errors in technique
◦ Avoid Acronyms
 Instead of “HDL,” explain “good cholesterol”
◦ Avoid Abbreviations & Technical Terms
 Instead of “anti-hypertensive,” explain “drugs that help to
lower blood pressure”
◦ Be Specific & Clear
 instead of “don’t go crazy with salt,” explain “keep your
salt intake to ___mg a day”
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What do you already know about…?

What would you like to know more about...?

What happens when you don’t take...?

Show me how you will do this once you are
back at home.
◦ I want to make sure I did a good job
explaining this to you

40-80% of the medical information patients
receive is forgotten immediately
True
False

40-80% of the medical information patients
receive is forgotten immediately
True

This approach to patient education is
evidence-based and supports safe patientand family-centered care
True
False

This approach to patient education is
evidence-based and supports safe patientand family-centered care
True

The teach-back method can be used for the
following:
◦
◦
◦
◦
◦
A. medication teaching
B. techniques
C. dressing changes
D. diet
E. all of the above
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The teach-back method can be used for the following:
◦ E. All of the Above
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Teach-back is:
◦ A. providing patient education when the patient is
anxious, hurried or distracted
◦ B. watching an instructional video twice
◦ C. asking patients to repeat in their own words
what they have just learned
◦ D. hurried instruction on the day of discharge

Teach-back is:
◦ C. asking patients to repeat in
their own words what they have
just learned

When talking with patients and families,
always:
◦
◦
◦
◦
A. talk slowly
B. use plain language
C. check for understanding using teach-back
D. all of the above

When talking with patients and families,
always:
◦D. all of the above

Patient understanding is confirmed when:
◦ A. they explain it back to you correctly
◦ B. they demonstrate insulin administration
accurately
◦ C. they are able to teach their spouse
◦ D. they sign their discharge instructions

Patient understanding is confirmed when:
◦ A. they explain it back to you correctly
◦ B. they demonstrate insulin administration
accurately
◦ C. they are able to teach their spouse

It is important to make sure patients
understand the prescribed medication
regimen and how they will take their
medications once they go home
True
False

It is important to make sure patients
understand the prescribed medication
regimen and how they will take their
medications once they go home
True
Case Studies


Case Study #1- A 9-month-old infant was
seen by her pediatrician for treatment of
Otitis Media and was prescribed amoxicillin.
The MD gave the first dose to the infant in
the office, demonstrating step-by-step how
to deliver the medicine via syringe.
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At home:
Dad drew up the next dose without removing
the syringe cap.
He gave the dose to the child who suddenly
had difficulty breathing and collapsed.
When EMS arrived the child was intubated and
transported, but she could not be adequately
ventilated. Intubation was attempted again
without improvement.


When the infant underwent bronchoscopy,
the syringe cap was found lodged in her
trachea.
Evaluation revealed brain death; the infant
was removed from life support and died
shortly thereafter.


Providing patients with a visual
demonstration can enhance communication,
but does not guarantee future success
In taking the extra step of asking the patients
to demonstrate back, we can detect
misunderstandings


Two patients were given a new medication,
Spiriva, for treatment of COPD.
The Pulmonologist gave them detailed
instructions for use.


During follow-up appointments, neither patient
reported an improvement in symptoms.
Upon further questioning, the patients were
found to be swallowing the capsules meant for
oral inhalation!


How common are misunderstandings
regarding medication instructions?
How can the system be re-engineered to
reduce the incidence of communicationrelated adverse events?
“It is neither just, nor fair, to expect a patient
to make appropriate health decisions and
safely manage his care without first
understanding the information needed to do
so.”
Reducing the Risk by Designing a Safer, Shame-Free Health Care Environment, AMA, 2007
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www.hsph.harvard.edu/healthliteracy
Kessels RP. Patients’ memory for medical
information. J R Soc Med. May 2003;96(5):219-22.
Iowa Health System
Maine Medical Center
HCAHPS Handbook, 2010