Heart Failure Education
Transitions of Care Project
Health Care Reform
SPECIAL
POINTS OF
INTEREST:



Health Care Reform
...
PAGE

2

Heart Failure Transitions of Care AIM:
To develop a reliable process to deliver standardized
Heart Failure Educat...
What is the Heart Failure Bull’s Eye about?
The Heart Failure Bull’s Eye is
about engaging the patient as
well as the heal...
Teach Back Is the Only Way We Know for Sure
Current national research demonstrates that even
though teach back is a highly...
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Just-in-Time Education for staff nurses about teaching patients about CHF

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Just-in-Time Education for staff nurses about teaching patients about CHF

  1. 1. Heart Failure Education Transitions of Care Project Health Care Reform SPECIAL POINTS OF INTEREST:  Health Care Reform  Transitions of Care Project  Bull’s Eye  Teach Back Contributors: Shelly 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 discharge planning. 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.
  2. 2. PAGE 2 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? Caption describing picture or graphic. 1. 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 Improvement 7N Team Members involved in this project:  Erin Bucha  Greg Harrington  Rita Hayle  Leslie Sigler Define which patients receive the bifold v. the book Mara Hutchings  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, every time.  Kristen Bartlett   Cayce Ake  3. Set Clear Roles and Expectations 4. Deliver evidence based patient education using the principles of teach back.   5. 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  HEART FAILURE EDUCATION 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.
  3. 3. 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.  RN  MD during rounds  Transition Care Coordinator  Pharmacist  Nutritionist Red: We provide the education.  Yellow: We assess their knowledge of the education through the principles of teach back. Case Manager    Green: We see the patient perform the skill related to the education provided. PAGE Seeing every health care team member address the bull’s eye reinforces to the patient the importance of acquiring the knowledge. 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 readmissions. Bull’s Eye in patient’s room Each healthcare provider will fill in a heart when the patient meets that goal. 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. 3
  4. 4. 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 conversation?  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. Key Points: 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 ourselves. 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 terms.  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.  Use humor.  Creating psychological safety is important.  Circle important points on handouts.  Draw pictures as needed. Patient Safety “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

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