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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 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” 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 The teach-back method can be used for the following: ◦ E. All of the Above 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. 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 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