Just-in-Time Education for staff nurses about teaching patients about CHF
Heart Failure Education
Transitions of Care Project
Health Care Reform
Health Care Reform
Transitions of Care
Padgett, Pam Bruce, Melissa Powell, Brittany Cunningham
The Transitions of Care
Team began working with the
Multidisciplinary Heart Failure
Team a few months ago to
develop standardized processes around patient education for heart failure patients.
The Transitions of Care
Team is the same team that
helped us successfully implement transition huddles to
facilitate the coordination of
Why Heart Failure?
The Affordable Care Act established the Hospital Readmissions Reduction Program,
which requires CMS (Centers
for Medicare and Medicaid
Services) to reduce payments
to hospitals with excess readmissions, effective for discharges, beginning on October 1, 2012.
The VUMC Pillar Goal for
Heart Failure Readmissions is
15.6%. Our most current
data in May shows we met
the goal with a readmission
rate of 13.2%. However,
consistency is the key. Since
January 2012 we have only
met this goal 53% of the time
(9 out of 17 months).
Readmission is defined as an
admission to a hospital within
30 days of a discharge from
the same or another hospital.
Keep reading to learn your
role in reducing heart failure readmissions.
Heart Failure Transitions of Care AIM:
To develop a reliable process to deliver standardized
Heart Failure Education across the continuum while
utilizing consistent tools and content
How do we reach the AIM?
picture or graphic.
Develop Standardized Content
All patient education content is available in the new
rack located in the middle hallway on 7N
Heart Failure Bull’s Eye—Multidisciplinary
Patient Education & Engagement Tool
Living Well with Heart Failure—bifold
Understanding Heart Failure—book
2. Develop a Reliable Process
Involve key stakeholders in helping define the process—VHVI Bedside Nurses
Develop a plan for the Heart Failure Bullseye: The
admitting nurse will hang the Heart Failure Bullseye in every patient room admitted with Heart Failure. The tool should hang below the whiteboard in the
patient’s room. This initiative starts 7/9/13.
-Institute for Healthcare
7N Team Members
involved in this project:
Define which patients receive the bifold v. the book
Next steps: Develop a teaching pathway based on 3 day length of stay that
includes specific content delivered on each day of hospital stay—every patient,
3. Set Clear Roles and Expectations
4. Deliver evidence based patient education using the principles of teach back.
Principles of Teach Back has been assigned as a learning module in The Learning
Exchange. Log in to make sure you have completed yours.
Teach Back Facilitators will observe RN teaching sessions and provide 1:1 feedback.
Expand PEER out of the pilot phase to see patient progression across the continuum.
Staff education on PEER Version 2 being planned
TRANSITIONS OF CARE
PEER Version 2 is currently being built
After implementation, the leadership team is to incorporate teaching record
audits into daily Quality Huddles.
What is the Heart Failure Bull’s Eye about?
The Heart Failure Bull’s Eye is
about engaging the patient as
well as the health care provider.
Education is done by the multidisciplinary team. We each
have a role to do.
The goal is to have every health
care team member addressing
the bull’s eye when they enter
the patient’s room.
The ultimate goal is to see the
patient progress toward the
center of the bull’s eye.
MD during rounds
Transition Care Coordinator
Red: We provide the education.
Yellow: We assess their
knowledge of the education
through the principles of
Green: We see the patient
perform the skill related to
the education provided.
Seeing every health care team
member address the bull’s eye
reinforces to the patient the
importance of acquiring the
The long term goal is to see the
patient progress toward self
care—to provide care for
themselves at home, analyze the
information before them (i.e.
VS, weight, and symptoms) and
make informed decisions about
their care by calling the doctor
at early recognition of warning
signs and preventing hospital
Bull’s Eye in patient’s room
will fill in
Remember: the bull’s eye is your patient engagement tool. It will be given to the patient
upon discharge. You will still document in the patient’s record all teaching that was done.
Teach Back Is the Only Way We Know for Sure
Current national research demonstrates that even
though teach back is a highly effective strategy, it is
used only about 39% of the time by physicians and
nurses to check for patient understanding as part of
a larger approach to education and engagement.
the patient does or does not understand.
Why don't we use it?
Ask patient and family to explain using their own
words (not yes/no questions).
Word questions in a non-shaming manner: Can
you tell me what you will tell your wife about our
The responsibility is on you the healthcare team
member: I want to make sure I did a good job of
explaining this well to you. Can you tell me…
Chunk and Check Method: Teach 2-3 main
points and check for understanding before moving on to the next concept.
We don’t think we need to do it. We make
assumptions that clearly the patient “gets it.”
The patient is smiling and nodding appropriately and they said they don’t have any questions.
We think we are already doing it.
Fast food restaurants do it well at the drive thru
window. Why can’t we?
Time—we think we save time by not doing it.
In reality we may be creating more work for
Teach Back is the only way we know for sure what
Elements of Good Patient Teaching
Use a caring tone of voice and attitude.
Use plain language—no medical
Simple, living room language
Sit down with the patient giving them
your undivided attention.
Make eye contact
Use positive reinforcement through
nodding and gestures.
Create a comfortable atmosphere
with small talk.
We set people at ease by trying to
relate to them, demonstrating empathy and caring.
Creating psychological safety is important.
Circle important points on handouts.
Draw pictures as needed.
“Asking that patients recall and restate what they have been
told” is one of 11 top patient safety practices based on the
strength of scientific evidence.—AHRQ, 2001 Report, Making
Health Care Safer