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T EACH ‐ B ACK I MPROVING P ATIENT S AFETY AND E NGAGEMENT October 23, 2019 GPQIN Staff Jennifer Geisert Kathleen Panas Sally May Lisa Thorp RN, BSN MPH RN, BSN, CH ‐ GCN RN, BSN, CDE Quality Improvement Advisor Quality Improvement Senior Quality Quality Improvement Consultant Improvement Specialist Specialist Nebraska Kansas North Dakota North Dakota 2 W ELCOME AND R EMINDERS  Use chat for questions and comments  Slides and recording will be available on the GPQIN website in 7 ‐ 10 days  http://greatplainsqin.org 3 1

F RAMING THE DISCUSSION Objectives: 1. Define teach ‐ back and role in improving patient safety and engagement. What is teach ‐ back? Why use teach ‐ back? 2. Practice the use of plain language. What is plain language? 3. Review the ten key elements of teach ‐ back. How do we use teach ‐ back? 4. Evaluate use of Teach ‐ back using Teach ‐ Back Observation Tool. How do we implement teach ‐ back? What about training? What teach ‐ back resources are available? 4 CEU FOR N URSES : 1.0 C ONTACT H OURS For individual attendees:  You will be redirected to the required evaluation when you close out of this webinar  Certificate will be emailed in 3 ‐ 5 business days to individuals completing the evaluation For multiple attendees:  An email with a link to the required evaluation and instructions to forward the email to fellow attendees will be sent to all individuals who logged into this webinar  Certificate will be emailed in 3 ‐ 5 business days to individuals completing the evaluation [email address is required] 5 T EACH ‐ B ACK : W HAT I T I S  A evidence ‐ based health literacy intervention that improves • Patient engagement • Patient safety • Adherence • Quality  Ask patients or family members to explain in their own words what they need to know or do, i.e., teach ‐ back  A way to confirm that you clearly explained information https://www.ahrq.gov/professionals/quality ‐ patient ‐ safety/patient ‐ family ‐ engagement/pfeprimarycare/teachback.html  A way to check for understanding 6 2

T EACH ‐ B ACK : W HAT I T I S “ Preparing an explanation using plain language before the interview, asking open ‐ ended questions, ensuring that the teach ‐ back is encouraging and comfortable for the patient. ” Nursing Student 7 T EACH ‐ B ACK : W HY U SE I T We pursue patient education To increase knowledge and skills in order . . . To increase self efficacy and self ‐ ‐ To increase adherence to and effectiveness of therapy management To enhance self esteem, ‐ To reduce physical morbidity To reduce psychosocial decision making capacity, and ‐ and risk of mortality stress and anxiety satisfaction with care To improve quality of life Feudtner, C. What are the goals of patient education . West J Med. 2001 Mar; 174(3):173 ‐ 174. 8 T EACH ‐ B ACK : W HY U SE I T We pursue patient education To incr ease knowledge and sk ills in order . . . To increase adhere nce to and To increase self efficacy and self ‐ ‐ effectiveness of therapy management To enhance self es ‐ teem, To reduce physical morbidity To re duce psyc hosocial decision making capa ‐ city, and and risk of mortality st ress and anxie ty satisfaction with care To impr ove quality of life Feudtner, C. What are the goals of patient education . West J Med. 2001 Mar; 174(3):173 ‐ 174. 9 3

You have what is called blah blah blah blah blah. Does he realize how long it has been since I studied anatomy and physiology of the eye? T HE T YPICAL P ATIENT You‘re a nurse – E XPERIENCE you don’t have any questions. 10 TEACH ‐ BACK : W HY U SE IT Did you know . . .  Only 12% of literate Americans are proficient in understanding health information 1  Patients forget up to 80% of what is told them at a clinic visit 2  If they do remember, only half of what they remember is correct 3 1. Minnesota Partnership for Health Literacy 2. Kessels RP. Patients’ memory for medical information. J R Soc Med 2003;96(5):219-22. 3. Anderson JL, Dodman S, Kopelman M, et al. Patient information recall in a rheumatology clinic. Rheumatology 1979;18(1):18-22. 11 T EACH ‐ B ACK : W HY U SE I T  Confirm that your patients have a clear understanding of your description or instructions  Prevent misunderstandings that would affect adherence to the treatment plan or medication regimen  Minimize post visit clarifying phone calls and emails 4

T EACH ‐ B ACK : W HY U SE I T The problem with communication is the illusion that it has occurred. George Bernard Shaw July 26, 1856 – November 2, 1950 13 W HAT IS PLAIN LANGUAGE ? Using plain language A communication is in plain language if its wording, structure, and design are so clear that the intended audience can easily find what they need, understand what they find, and use that information. Source: International Plain Language Federation 14 P RACTICE : P LAIN L ANGUAGE Martha’s husband has heart failure. Recently, a friend told her that because of his heart failure he should not have any salt. One day in the clinic she asked you for information about “salt.” You give her the FDA Sodium Food Label brochure , the patient education brochure your organization uses . . . 15 5

P RACTICE : P LAIN L ANGUAGE  The opening paragraph . . . The words “salt” and “sodium” are often used interchangeably, but they do not mean the same thing. Sodium is a mineral and one of the chemical elements found in salt. Salt (also known by its chemical name, sodium chloride ) is a crystal ‐ like compound that is abundant in nature and is used to flavor and preserve food. Helpful? 16 P RACTICE : P LAIN L ANGUAGE 17 Q UE UESTION : The better choice? 18 6

T EACH ‐ B ACK : H OW TO USE IT Using plain language Guide to Improving Patient Safety in Primary Care Settings by Engaging Patients and Families. Content last reviewed May 2018. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/profession als/quality ‐ patient ‐ safety/patient ‐ family ‐ engagement/pfeprimarycare/tea chback.html 19 Hand out Responsibility is on the healthcare professional 1. Use a caring tone of voice and attitude 2. Display comfortable body language and make eye contact 3. Use plain language not medical terminology “The doctor has changed how much medicine you should 10 Elements of Competence for take and that can be Using Teach ‐ back Effectively confusing . . .” http://www.teachbacktraining.org/assets/files/PDFS/Teach% 20Back%20%2010%20Elements%20of%20Competence.pdf 20 Hand out 4. Ask the patient to explain back using their own words “Tell me what you will do when you get home.” 5. Use non ‐ shaming, open ‐ ended questions “Because you have several new pills, what will you do if you forget to take them one 10 Elements of Competence for morning?” Using Teach ‐ back Effectively http://www.teachbacktraining.org/assets/files/PDFS/Teach% 20Back%20%2010%20Elements%20of%20Competence.pdf 21 7

Hand out 6. Avoid asking questions that can be answered with a simple yes or no. “Do you know how to use your inhaler?” 7. If the patient is not able to teach ‐ back correctly, explain again and re ‐ check 8. Emphasize that the responsibility to explain clearly is on you “You have had a busy appointment today and I want to make sure that my explanation of your medication changes was clear. What are some 10 Elements of Competence for signs you need to watch for due to Using Teach ‐ back Effectively the changes in your medications?” http://www.teachbacktraining.org/assets/files/PDFS/Teach% 20Back%20%2010%20Elements%20of%20Competence.pdf 22 Hand out 9. Use reader ‐ friendly print materials to support learning 10. Document use of and patient response to teach ‐ back 10 Elements of Competence for Using Teach ‐ back Effectively http://www.teachbacktraining.org/assets/files/PDFS/Teach% 20Back%20%2010%20Elements%20of%20Competence.pdf 23 Teach ‐ Back Demonstration Julie has just been told that she has hypertension. She wants to know what that means. . . . Audience participation: Enter into chat the various elements of teach ‐ back that you observe using the 10 Elements of Competence for Using Teach ‐ back Effectively handout. 24 8

T EACH ‐ B ACK : W HEN TO USE IT  A new diagnosis  Medication need and proper use  Home care instructions  Recommended behavior changes  Treatment options  Treatment plan  Use of a new device  Next steps 25 T EACH ‐ B ACK : H OW I S I T I MPLEMENTED ? Guide to Improving Patient Safety in Primary Care Settings by Engaging Patients and Families includes: • Implementation guide • Teach ‐ back tips (job aid) • Slides • Role play scenarios • Interactive module Guide to Improving Patient Safety in Primary Care Settings by Engaging Patients and Families. Content last reviewed May 2018. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality ‐ patient ‐ safety/patient ‐ family ‐ engagement/pfeprimarycare/teachback.html 26 T EACH ‐ B ACK : H OW I S I T I MPLEMENTED ?  Review intervention and training materials  Implementation decisions • Scope • Workflow: Documentation • Champion  Customize training  Train team members • Pre ‐ work: Interactive module (20 ‐ 30 min) • Teach ‐ back Clinic (20 ‐ 30 min)* *30 ‐ 45 min if plain language exercise included  Go live 27 9