1. Teach-back Method for Patient Education Tracy Grant Viterbo University

2. Definition of Teach-back Method  It can also be called the “show me” method.  After a health care provider teaches a concept, then confirmation of the patients understanding is assess by asking them to explain the concept back accurately (Xu, 2012).  Teach-back is an evidence based approach used to ask patients to repeat in their own words what they need to know or do using a non-shaming approach (Tamura-Lis, 2013).  A way to make sure the health care provider explained information clearly. It is not a test or a quiz for the patient.

3. PICO Question  Would a patient who starts a new medication and receives teach-back education have improved outcomes (medication compliance, better understanding of the disease state, or control over the disease) than a patient who received other teaching methodologies (handout or verbal explanation)?  P: Patient starting a new medication  I: Received teach back education  C: Other teaching methodologies (handout or verbal explanation)  O: Improved outcomes (medication compliance, better understanding of the disease state, or controlled disease state)

4. Those interviewed

5. Areas of Practice

6. Years of Practice

7. Why should the teach-back method be used?  Promote health literacy. Health literacy is the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. More than one third of all American adults or 89 million individuals lack sufficient health literacy to understand and participate in preventative health care.  Promotes communication between health care providers and patients.  Minimizes the risk of patients misunderstanding critical information in the clinical setting.  Optimize patient learning, comprehension, and satisfaction. (Tamura-Lis, 2013)

8. Evidence of using the teach-back method  Increases adherence to disease management.  Makes a patient more accountable and active in their own health.  Increases patients’ confidence in health management.  Patients understand their condition.  Improved patient and family satisfaction, safety, and quality care.  Improve health outcomes.  Reduce hospital readmissions  Decrease healthcare cost (Xu, 2012, American Nurses Today)

9. Elements of Teach-back Method  Use a caring tone of voice and attitude.  Display comfortable body language and make eye contact.  Use plain language.  Ask the patient to explain back, using their own words.  Use non-shaming, open-ended questions.  Avoid asking questions that can be answered with a simple yes or no.  Emphasize that the responsibility to explain clearly is on the health care provider.  If the patient is not able to teach back correctly, explain again and re- check.

10. What teaching methods might be implemented to improve patient outcomes?  SBAR with teach-back  Get Well Network  Demonstrations  Staff education on topics of interest

11. Examples when Teach-back can be used  All encounters with patients  A new diagnosis  A new medication (warfarin, lovenox, inhalers)  Consents for procedures (IUD, mole removal, cyst removal)  Discharge instructions  Follow up phone calls and/or phone calls for advise  New self care technique (wound care, self catheterization)  Care planning or goal setting  With handout and video education

12. Examples of Teach-back Questions  What questions do you have for me?  I want to make sure that I explained your new medication clearly. Can you tell me what your medication does and when you should take it?  Tell me why you should take your pill regularly?  What symptoms do you need to tell your doctor about?  What are you going to do when you get home?  How would you explain this to your spouse/family/friend?  What foods should you not eat (or not eat a lot of) when taking this medication?  Can you tell me in your own words, what is our plan?

13. Follow up from teach-back, how and when  Phone call  Next appointment with nurse or provider  Ask the patient when they would like to follow up  Sometimes it is not needed  Continuously if it is a disease state

14. Educational level that material is provided  5 th grade level  High school level  Depends on patient and assessment

15. Barriers With Using the Teach-back Method  Time for both the patient and the staff  Health care providers are not educated on using the teach back method  Health Literacy, not understanding education provided  Patients may feel annoyed by the questions  Patient willingness to listen, compliance, resources  Proper documentation of the education provided  Not standardization of education that is provided  Confused patient or medicated patient  No support system for the patient  Emotional state of the patient

16. What needs to be done to implement Teach-back method?  Staff education  Education materials need to be in easy to understand language (5 th grade level)  Some standardization of educational materials provided to patients  Proper documentation of the teach-back method, and when follow up is needed  Motivational interviewing, use of open-ended questions  Assess how the patient prefers to learn material

17. Question When and how often do you currently use the teach-back method? What other opportunities can you use the teach-back method in your practice that may be currently missed?

18. References Tamura-Lis, W. (2013). Teach-back for quality education and patient safety. Urologic Nursing, 33(6), 267-271. doi:10.7257/1053-816X.2013.33.6.267 Xu, P. (2012). Using teach-back for patient education and self-management. Retrieved from: https://americannursestoday.com/using-teach-back-for- patient-education-and-self-management/https://americannursestoday.com/using-teach-back-for- patient-education-and-self-management/ www.teachbacktraning.org/assets/files/PDFS/Teach Back - 10 Elements of Competence.pdf