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Evidence Based Project: Comparing “ Teach Back Method ” with current teaching methods to improve patients knowledge and understanding. Kristi McSwain BSN, RN & Dana McCrone, MSN, RN, CNL September 13,2010. INTRODUCTION: THE NEED FOR CHANGE. What the current literature is telling us:.
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Evidence Based Project: Comparing “Teach Back Method” with current teaching methods to improve patients knowledge and understanding. Kristi McSwain BSN, RN & Dana McCrone, MSN, RN, CNL September 13,2010
INTRODUCTION: THE NEED FOR CHANGE What the current literature is telling us: Due to lack of education patients are not following treatment regimens. 1 Readmission rates increase when patients do not have a clear understanding of illness and disease processes. 2 In 2013 CMS will decrease reimbursement for hospitals with high readmission rates and low patient satisfaction. . 3 Centers for Medicare and Medicaid Services (CMS) spend billions of dollars for readmissions occurring within 30 days post intervention and post discharge. 4 Disease processes requiring intense self monitoring are currently the top three readmissions occurring within 30 days of discharge from acute care facilities in the United States. 5 The Joint commission as outlined there is strong correlation with poor patient satisfaction and patients understanding of illness and treatment regimens. 6 7
LEWINS THEORY OF CHANGE CHANGING TEACHING PROCESSES Unfreeze Remove old teaching methods Moving to a new level Teach-Back Method Recognizing the role of habit by using evidence base data will recognize old methods of teaching are not as effective as the teach-back method and will reinforce the need for change. Refreeze new teaching method
Plan • Change current methods of discharge education • Improve patient satisfaction and decrease hospital readmission There is an opportunity to decrease readmission rates, increase patient satisfaction, and improve patient outcomes by improving patient understanding of new medications utilizing the teach back method.
Pilot Teach Back Method Heart Three North Baptist Medical Center Downtown Jacksonville Current discharge medication education process Change Incorporate teach-back method with medication reconciliation forms Currently our discharge process utilizes a tri-copy paper form for medication reconciliation. The medication reconciliation form has a section for newly prescribed medications at discharge. When a patient is discharged a copy will be placed on the chart (white), a copy is given to the patient (yellow), and a copy collected for hospital use (pink). Tthe teach back method gowes A ldTThe teach back method goes beyond providing information verbally or in writing. It is interactively sharing the medical information while maintaining the awareness of the patients education level in simple terms to avoid the use of medical vocabulary. 1 2
The projected time line 7 months Base line data will be collected on heart three north. Two registered nurses will be trained to do follow up phone calls to patients discharged. Patients discharged home with a new prescription will be called within 48-72 hours. Patients will be excluded if they are unable to be reached by phone within 48-72 hours and unable or unwilling to answer survey questions. Initial three Months Gather Baseline Data IImplement Teach-Back Method Baseline medication retention and comprehension will be collected by follow up phone calls. Baseline patient satisfaction data will consist of data reported by NCR Picker After baseline data is collected the staff will be taught the teach-back method of communication with validation. Three months of post data will be collected and evaluated. Three Months Evaluation of Post Data
Implementation The Teach Back Method • Open ended questions • Use simple language • Ask • Identify and Correct • Demonstrate • Repeat The teach-back method goes beyond providing information verbally or in writing. Method developed by Dean Schillinger, MD and is a proven method to improve retention and comprehension in patients.
Gather Data: Unit Call Back Can you list for me the names of your new medications? 1 2 How often do you take your new medications? 3 Can you tell me the purpose of your new medications? 4 Could you explain to me a possible side effect your new medications may have? 5 Before moving on to questions not related to your medications, Do you have any questions about your medication that I could answer or explain?
Evaluation Evidence Based • NCR Picker survey is conducted to evaluate patients satisfaction. • Four of the survey questions are specific to medication and education will be queried for evidence of improvement of teaching methods
NRC specific questions During this hospital stay, how often did nurses explain things in a way you could understand? Before giving you any new medicine, how often did hospital staff describe possible side effects in a way you could understand? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? Did someone on the hospital staff explain the purpose of the medicines you were to take at home in a way you could understand?
References Schein, E. H. (1995). Kurt Lewin's Change Theory in the Field and in the Classroom: Notes toward a model of managed learning. Working Paper 3821.
