Implementing teach-back using improvement methodology 11 th March 2013 Julie Adams Senior Programme Manager, NSD

Wave 18

The Project!

My project

Evolution of the aim: Children not taking the prescribed dosage (compliance) for their inhalers – preventable hospital admissions Inhaler technique Discrepancies between hospital and community pharmacy systems Health literacy issues Preventative Care / Acute Management Medicines reconciliation Specialist Clinic Re-admissions

Home ‘self- management’ G.P. ‘primary care’ Respiratory Clinic ‘specialist care’ Hospital ‘paediatric ward’ Child’s Care Pathway

Baseline data

Sample from Respiratory Clinic Attendees (Jan-March 2011) - healthcare professional who delivered initial inhaler technique training

One Puff Ten Breaths 30 seconds between ‘puffs’ Multi-dose technique in NHS Lanarkshire

What are we trying to accomplish? Improve self- management processes linked to asthma medication during an acute inpatient admission, by June Outcome Aim: Increase asthma medication self management for children admitted to Wishaw General Hospital paediatric ward, with asthma or viral wheeze by July Evolution of the aim: Children not taking the prescribed dosage (compliance) for their inhalers – preventable hospital admissions Inhaler Technique Teach-Back Technique Use own inhaler medication Staff Education Children discharged - using correct inhaler technique Measure of Compliance Medicines Reconciliation Children discharged - using correct inhaler dosage

Increase asthma medication self management for children admitted to Wishaw General Hospital paediatric ward, with asthma or viral wheeze by July Asthma medication – medicines management processes Self-management Discharge processes Children bring their asthma medication into hospital within 24 hrs of admission Asthma medication reconciled prior to discharge Asthma discharge checklist compliance Standardised discharge self-management education Inhaler technique training highlighted at nurse handovers, safety briefings and multi-disciplinary ward rounds. Children/parents involved in discharge medicines reconciliation Ward staff delivering asthma self-management education Inhaler technique training Asthma medication reconciled within 24 hours of admission 95% of all children will receive asthma inhaler technique training prior to discharge. % of children with own inhaler on ward % of staff trained to deliver asthma inhaler technique training % of self-management education delivered by ward staff ward % of inhaler medication reconciled on admission Measures Self-management of asthma medication

Developing teach-back tools & training Methods to check understanding Please show me how you use the asthma inhaler? When you feel wheezy - what will you tell your mum, dad or teacher should happen? ‘We discussed a lot today. Can you tell me what you found most important about your child’s condition?’

Measures…… Measure – operational definition: Choose random day of the week and ask first 5 members of staff on Wd 20, from middle of May (post-training - every 2 weeks) about inhaler technique / teach-back mechanism – using same questions. To assess what percentage describe the correct multi-dose technique/confidence in using teach-back. Sample 1Sample 2Sample 3Sample 4Sample 5 Weekly Total Week Beginning Can you describe multi-dose inhaler technique? 1 puff/10 breaths/30 seconds between puffs. (enter 1-Yes or 0-No) Have you had the teach-back training? (enter 1-Yes or 0-No) Can you describe the teach-back? (enter 1-Yes or 0-No) Are you confident in using teach-back? 1 – Strongly Disagree (really not confident – wouldn’t want to try) 2 – Disagree (not really confident – prepared to try) 3 – Undecided (not sure – haven’t had opportunity to try it) 4 – Agree (confident about technique – have/haven’t used it) 5 – Strongly Agree (very confident – can give example of using technique) Have you used teach-back with parents? (enter 1-Yes or 0-No)

NHS Lanarkshire / IA – Asthma Inhaler Project Implementation of Teach-back training

Measures…… Plateau of training

Outcomes – medicines reconciliation

Outcomes – inhaler technique

Results….. Data collection issues – within 24 hrs / prior to discharge

Measure – operational definition: Assess effectiveness of inhaler technique training delivered, during in-patient episode on Wd 20. All new referrals will be asked about:  multi-dosing technique;  teach-back. (Outcome measurement to assess effectiveness of multi-dosing technique & teach-back.) Sample 1 Sample 2 Sample 3 Sample 4 Sample 5 Sample 6 Sample 7 Sample 8 Weekly Total Week Beginning Referral Pathway: (enter: GP or Paediatric Unit WGH) Outcome Measure: percentage of new referrals – that required inhaler-technique training. (enter 1–Yes or 0-No) Did anyone teach you how to use the inhaler? (enter: GP, WGH, No) Ask parents – can you tell me how to use your child’s inhaler? How many described the correct multi-dose technique: 1 puff/10 breaths/30 seconds between puffs. (enter 1-Yes or 0-No) If child has been in WGH – can the parents describe how the inhaler technique was taught to them – did they describe a teach-back method? (enter 1-Yes or 0-No) Asthma Inhaler Project – Data Collection: Outpatient Clinic assess new referrals knowledge of multi-dose technique Clinic: _________________________ Asthma Inhaler Project – Data Collection: Outpatient Clinic assess new referrals knowledge of multi-dose technique Clinic: _________________________ Asthma Inhaler Project – Data Collection: Outpatient Clinic assess new referrals knowledge of multi-dose technique Clinic: _________________________

Implementation of system of reviewing asthma multi-dose inhaler technique - using teach-back. The Respiratory Clinic: –increase in no. children demonstrating correct inhaler technique (after hospital admission); –reduction in need for specialist education. Conclusion: –benefits of teach-back demonstrated. Next Stage: –monitor readmissions; –engage with primary care clinicians to support inhaler technique education within primary care. Achievements so far…..

Ingredients for successful project: IA skills: Leader motivateinfuse teachermentor imaginationteamwork success

Any Questions?