Teach Back

1. Teach Back Engaging Patients and Evaluating Learning

2. Learning Objectives • Define Teach Back • Discuss how Teach Back can improve patient understanding of discharge instructions and help prevent hospital readmissions • List appropriate questions used to elicit a patient’s Teach Back • List four essential principles of Teach Back. • Practice using Teach Back skills in a role play

3. Why Teach Back? • Helps to reduce 30 day hospital readmissions • Common causes for readmission: • Lack of patient/family involvement and accountability in their own health care • Patients/families do not fully understand how to care for themselves at home Reference: A. Boutwell and S. Hwu, Effective Interventions to Reduce Rehospitalizations: A Survey of the Published Evidence (Cambridge, Mass.: Institute for Healthcare Improvement, 2009), p. 14.

4. Teach Back is a way to evaluate our deliveryof patient education in a way that continues to engage the patient and family

5. Why Traditional Teaching Methods Fall Short • Providers give too much information • “need to know” • Patient may not have been involved in the development of the plan • Patients may not realize the importance of education at the time it is given

6. Patients may not understand the information provided (Low health literacy) • The stress of hospitalization and/or the patient’s diagnosis limits their ability to concentrate and understand

7. Principles Of Adult Learning • Addresses individual’s immediate need • “Burning question” • Centered on the person & their concerns • Relate content to existing knowledge & experiences

8. Adult Learning Principles • Active participation in varied learning activities • Collaborative process, educator acts as the facilitator

9. People Remember: 10 % of what they read 20% of what they hear 30% of what they see 50 % of what they hear and see 70% of what they say or write 90% of what they do

10. Patient Education and Motivational Interviewing • MI = Collaborative conversation about change • Engages and focuses the patient • Evocative: calls forth person’s own motivation and commitment for behavior change

11. Teach Back and MI • Elicit – Provide - Elicit • Check – Chunk - Check

12. People are generally better persuaded by the reasons for which they have themselves discovered than by those which have come into the mind of others. Blaise Pascal

13. “I explained EVERYTHING!” “I told my patient exactly what he should do…..” “The taxi’s here, just finished all my discharge teaching.” “Here are your prescriptions take them just as your doctor ordered” “Any questions? Ok, good!”

14. “ Do you understand? Do you have any questions?

15. What is Teach Back? The patient discusses and/or demonstrates key messages. Allows evaluation and affirmation of their understanding. • Accountability for patient learning is on the teacher • Respectful and non-shaming • Engages patients by asking them to state in their own words what they understand • Ideally the patient applies the information to their unique situation

16. Teach-back Explain Assess Clarify Understanding

17. Starting the Teach Back Conversation “I want to make sure I explained that clearly….” “I want to be sure you and your wife feel comfortable with your plan for going home…” “Let’s make sure I did a good job of going over this information”

18. Continue the Conversation with Good Questions “Would you mind repeating back to me what you heard me say?” “If you were to explain your diagnosis to your spouse, what would you say?” “Could you tell me 3 symptoms that mean you need to call your provider?” “Would you talk through your daily plan for taking your medications?”

19. Evaluate the Learning • If learner/patient can Teach Back key messages or topics, teaching has been successful • If patient cannot Teach Back, review content with a different approach • Ask the patient to Teach Back again, using his or her own words, until you are comfortable the patient understands

20. Effective use of Teach Back • Make sure you’re teaching the right person • Teach just a few main points, then stop and use Teach Back to check understanding: Chunk, Check • Use it whenever you teach, on any topic • Avoid doing all teaching in one session as the patient is walking out the door

21. Teach Back • Prioritize what you will teach • Stick to “need to know” information • Use Teach Back throughout the patient’s hospitalization

22. Teach Back & Mental Health • Assumptions • Readiness to learn • Evaluate patient’s understanding Mental Health

23. Improving Patient Outcomes • Build rapport • Improve compliance • Delivery of education • Group • 1:1 • Relevance to individual patient Mental Health

24. Connecting With Your Patient • Connect education to recovery • Accommodate for individual needs • How they learn (lecture, seeing, doing, etc.) • What are their resources? • Appraise for optimal times • Immediately after new information/skill is provided • New diagnosis • Change in plan of care • Intervention, medication changes • Discharge plan • Patient’s mood, readiness Mental Health

25. Utilize Tools • Tools • Crisis plan • Relapse prevention plan • Discharge medication list • Teach Back should be utilized throughout the hospital stay -before day of discharge Mental Health

26. Essential Themes • Key messages • Keep it simple • Applicable to patient’s life outside hospital Mental Health

27. Utilize Exploring Questions Mental Health What is waiting for you when you get home? What does your diagnosis mean to you? Describe those things you can do to take care of yourself. What things do you absolutely have to take care of in the first few hours of going home.

28. Documentation of Teach Back • Communicating & collaborating the key message • Document the outcome of patient education, including ability to Teach Back, according to your organizational guidelines • Electronic Medical Record (EMR) may be tailored to support documentation of Teach Back for specific discharge education • Documentation is important to reflect your practice and support quality improvement

29. Role Play - Scenarios • Self care • Skills to soothe • Time management • Relaxation therapy • Medications • Follow up appointments • Therapist • Psychiatrist • Primary care • Support groups Mental Health

30. Teach Back: Elements of Competence • Accountability is on the provider • Use a caring voice and attitude • Use plain language • Ask the patient to explain using his/her own words • Use Teach Back for all key points or “need to know” patient education, specific to his or her condition and life values • Document the use of Teach Back (Able to Teach Back) Mental Health

31. Role Playing • What phrase did your “provider” use to start Teach Back? • How was the patient asked to tell what he/she learned? • How was this patient a part of making his/her own plan for his/her own care? Mental Health

32. Wrap Up Role Playing • Do you feel certain this patient learned well from the teaching? How do you know? • How were key messages identified by the “provider” • Were these messages important to the patient? Mental Health

33. Take Aways? • Surprises? • Challenges? Mental Health

34. Scenario I Treatment Resistant Depression • Scenario: A 65 year old male with recurring depression. He’s been hospitalized three times in two yearsand twice in the past four months. Since his retirement three years ago he has struggled with symptoms of depression. His wife was recently diagnosed with renal failure and started dialysis. While hospitalized he has participated in education groups, including distress tolerance skills, developing a crisis plan, and discharge planning. • Instructions: Choose a topic to educate the patient (i.e. self-care, medications, or follow up appointments). After completing the patient education, evaluate his understanding by asking questions and/or having him demonstrate skills.

35. Scenario II Personality Disorder – Self Injurious Behavior • Scenario: A 22 year male with a history of physical abuse by his father. As a teenager he was hospitalized multiple times related to cutting. He is a full time student, and for several weeks he has increasingly become isolative, skipping class, experiencing thoughts of ending his life, and cutting on his thighs. A concerned friend brought him to the emergency department, he was subsequently admitted to the acute psychiatric unit for safety. The patient’s medications have been adjusted, his mood stabilized, he is contracting for safety, and the psychiatrist is planning to discharge him in a couple of days. • Instructions: Choose a topic to educate the patient (i.e. self-care, medications, or follow up appointments). After completing the patient education, evaluate his understanding by asking questions and/or having him demonstrate skills.

36. Scenario III • Anxiety • Scenario: A 40 year old female was admitted with increased anxiety. Recently she separated from her significant other and is experiencing difficulties at work. Initially she was unable to concentrate, making it difficult to attend groups. For the past week she has attended and participated in a variety of education groups, including distress tolerance skills, relaxation therapy, sleep hygiene, self-esteem, healthy lifestyles, survival skills, crisis planning, and discharge planning. • Instructions: Choose a topic to educate the patient (i.e. self-care, medications, or follow up appointments). After completing the patient education, evaluate her understanding by asking questions and/or having her demonstrate skills.

37. Scenario IV • Suicide Ideation • Scenario: A 34 year old female was hospitalized 7 days ago after overdosing on her antidepressant and drinking excessive amounts of alcohol. After failing to show up for work, a co-worker found her unconscious in her apartment. After 3 days in the ICU, she was transferred to the inpatient psychiatry unit. Despite leaving a suicide note to her boyfriend, she denies the attempt to end her life. The primary psychiatric team is ready to discharge her from acute care and notes that her medications were prescribed by a primary care provider. In addition to primary care, follow up appointments will include a psychiatrist and therapist. • Instructions: Choose a topic to educate the patient (i.e. self-care, medications, or follow up appointments). After completing the patient education, evaluate her understanding by asking questions and/or having her demonstrate skills.