1. Improving Patient Education
Teach Back
Improving Patient Education
Janet Grace, RN, BSN
Saline Memorial Hospital

2. Objectives Define teach-back and its purpose
Describe the key elements for using teach-back correctly
Apply in the clinical setting

3. The Challenge
40-80% of medical information patients receive is forgotten immediately and nearly ½ of the information retained is wrong.

4. The Challenge A common quote states we retain: 10% of what we read
20% of what we hear
30% of what we see
50% of what we see and hear
70% of what we discuss with others
80% of what we experience
95% of what we teach to someone else

5. Printed Discharge Instructions
Your naicisyhp has dednemmocer that
you have a ypocsonoloc. Ypocsonoloc
is a test for noloc recnac. It sevlovni
gnitresni a elbixelf gniweiv epocs
into your mutcer. You must drink a
laiceps diuqil the thgin erofeb the
noitanimaxe to naelc out your noloc.
Your physician has recommended that you have a colonoscopy. Colonoscopy is a test for colon cancer. It involves inserting a flexible viewing scope into your rectum. You must drink special liquid the night before the examination to clean out your colon.

6. What it Says….
Your physician has recommended that you have a colonoscopy. Colonoscopy is a test for colon cancer. It involves inserting a flexible viewing scope into your rectum. You must drink special liquid the night before the examination to clean out your colon.

7. What does this mean?
There is a bear in a plain wrapper doing flip flops on 78 handing out green stamps.

8. What does this mean?
There is a policeman in an unmarked car going up and down highway 78 handing out tickets.

9. The Right to Understand
Patients have the right to understand healthcare information that is needed for them to safely care for themselves
Healthcare providers have a duty to provide information in a simple, clear, and plain language AND to check that the patients have understood the information

10. Universal Communication Principles
Everyone benefits from clear information
Many patients are at risk for misunderstanding but it is difficult to identify them
Knowing the patient’s level of education does not ensure patient understanding

11. When Communicating with Patients and Families
Always:
Use plain language
Slow down
Break it down into short sentences
Focus on the 2 or 3 most important concepts
Check for understanding using teach-back

12. What is Teach Back?
Teach back is asking patients to repeat in their own words what they have learned
It is not a test of the patient, but of how well YOU explained the concept
It is a chance to check for understanding and, if necessary, re-teach the information

13. Why Use Teach-Back?
Improves the ability to assess understanding of teaching
Allows feedback & corrections of mis- understandings immediately
Increases patient’s confidence in providing self-care
Encourages active patient/family participation
Improves the transition from hospital to home
Improves the overall safety and quality of care

14. Confirming Understanding
Ask patients to acknowledge understanding using their own words.
Examples:
“I want to be sure I explained everything clearly. Can you please explain it back to me so I can be sure I did?”

15. Confirming Understanding
“What will you tell your husband about the changes that were made to your blood pressure medicines today?”
“We’ve gone over a lot of information, a lot of things you can do to get more exercise in your day. In your own words, please review what we talked about. How will you make it work at home?”

16. Confirming Understanding
Teach back provides the opportunity to confirm understanding BEFORE adding any new information.
Re-phrase the information IF the patient is unable to repeat the information accurately.
Ask them to repeat the information again using their own words.
Repeat the process until you are comfortable they really understand it.
If they still don’t understand it then consider other strategies.

17. Closing the Loop

18. Teach-back Additional Points
Do NOT ask yes/no questions like:
“Do you understand?”
“Do you have any questions?”
For more than one concept “Chunk and Check”:
Teach the 2-3 main points for the first concept & check for understanding using teach-back.
Then go to the next concept.

19. Teach Back Method Uses statements such as:
“I want to make sure I explained everything clearly to you. Can you please explain it back to me in your own words?” OR
“I want to make sure I did a good job explaining this to you because it can be very confusing. Can you tell me what changes we decided to make and how you will take your medicine now?”
If needed, clarify and reinforce the explanation to improve patient understanding.

20. Teaching the Topic The signs of heart failure: Dyspnea on exertion
Weight gain from fluid retention
Edema in your lower extremities and abdomen
Fatigue
Dry, hacky cough
Difficulty breathing when supine

21. Teaching the Patient
I am going to talk to you about the signs of heart failure. The signs of heart failure are:
Shortness of Breath
Weight gain from fluid build-up
Swelling in feet, ankles, legs or stomach
Dry, hacky cough
Feeling more tired, no energy
It’s harder for you to breath when lying down

22. What’s wrong with this? Shouldn’t be like a test.
Teaching the Patient
I’m going to talk to you about what you need to do every day at home to control your heart failure. Every day:
Weigh yourself in the morning before breakfast and write it down
Take your medication the way you should
Check for swelling in your feet, ankles, legs and stomach
Eat low-salt food
Balance activity and rest periods
List four things for me that you are going to do everyday
What’s wrong with this? Shouldn’t be like a test.

23. Teaching the Patient – Teach Back Method
I’m going to talk to you about what you need to do every day at home to control your heart failure.” Every day:
Weigh yourself in the morning before breakfast and write it down
Take your medication the way you should
Check for swelling in your feet, ankles, legs and stomach
Eat low-salt food
Balance activity and rest periods
I teach people about this every day, and sometimes I go over it quickly or may not make myself clear. I want to make sure you know what you need to do. So, can you tell me some things you will do each day?

24. Discharge Info When communicating follow-up appointment include:
Place, date, time
Access to transportation
Provider name and specialty
WHY they need to follow-up; be specific

25. Elements of Competence
Responsibility is on the provider
Use a caring tone of voice and attitude
Use PLAIN language
Ask the patient to explain using their own words – NOT yes/no
Use for all important patient information, specific to the condition
Document use of & response to teach-back.

26. Other
Without teach-back the only indicator of misunderstanding may be a medication error.
You might be surprised at the misconceptions patients have about their discharge instructions.
Nonverbal cues are not always reliable.
Include caregivers when giving discharge instructions- using Teach Back.

27. Questions to Consider
What are specific topics or directions you commonly discuss with your patient that you can use the teach-back method with?
Ideas: insulin injections, medications, chronic disease self-care, etc.
Inadequate knowledge of insulin, oral hypoglycemics and anticoagulants are common reasons for readmission

28. Practicing Teach Back Method
Each participant will participate in a role-play providing education to a patient. The following will be assessed:
Ability to do teach back in a shame-free way, e.g. tone is positive
Utilizes plain language for explanations
Does NOT ask patient, “Do you understand?”

29. Acknowledgements The Iowa Health System Health Literacy Collaborative
Santa Clara Valley Medical System in collaboration with Educational Services at Children’s Hospital of WI – 2010

30. Practice Teach Back