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Kelly Pick - Teach Back: Make Sure They Understand


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Presented by Kelly Pick, MSN, RN-BC NPD, on March 13, 2015 at the fifth Center for Health Literacy Conference: Plain Talk in Complex Times.

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Kelly Pick - Teach Back: Make Sure They Understand

  1. 1. Teach-Back: Make Sure they Understand Kelly Pick MSN RN-BC NPD Patient and Community Education PeaceHealth Southwest Medical Center
  2. 2. Last Trip to that Store 2
  3. 3. Who needs Teach-Back? employee colleague child 3
  4. 4. Key Resources AMA Health Literacy and Patient Safety: Help Patients Understand. Manual for Clinicians, Weiss et al. (2007) AHRQ Universal Precautions Toolkit, DeWalt, et al. (2010) Always Use Teach-back! Training Toolkit, AMA, Picker Institute, UnityPoint Health, Des Moines University, et al. (2014) 4
  5. 5. Health Literacy Weiss, B.D. (2007) 5
  6. 6. …for Low Health Literacy • Can’t tell by looking • Communicate clearly with everyone • Confirm understanding with everyone Universal Precautions… DeWalt, et al. (2010) AHRQ Universal Precautions Toolkit 6
  7. 7. Clear Communication • Slow down • Use plain, non-medical language “living room language” • Show or draw pictures • Create a shame-free environment • Use Teach-Back Weiss, B. (2007) 7
  8. 8. Teach-Back: What is it? 8
  9. 9. How does Teach-Back help? Health Care • Patient safety • Patient engagement and satisfaction • Reduces: –unnecessary clinic visits –emergency room visits –hospital re-admissions 9 Business/Government/Education • Provides clarity • Improves customer/constituent satisfaction Family and Friends • Better relationships All: Quick and easy way to assess understanding
  10. 10. “I don’t have time” Studies and Pilot Projects 10 Start small: • One patient encounter per day (last visit) • Work up to more as you get more comfortable • Practice at home
  11. 11. Key Learner Identify and involve as much as possible 11
  12. 12. Need-to-know versus Nice-to-know Needs Assessment 12
  13. 13. A Physician’s Experience 13
  14. 14. Chunk ‘n Check …if more than 2-3 points 14
  15. 15. Knowledge: Can you tell me how much insulin you should give yourself every day? Attitude: Do you know why it’s important for you to take your Lasix every day? Behavior: How do you plan to remember to take all your medicines correctly every day? Three Types of Questions: 15
  16. 16. Avoid yes/no questions • Do you understand? • Does that make sense? • Is that clear? Check for Understanding 16
  17. 17. Take Responsibility… I want to make sure you understand… Whose fault is it? 17 versus I want to be sure I’ve been clear...
  18. 18. Repeat back Avoid the Parrot 18 versus Teach back in your own words
  19. 19. What questions do you have? You don’t have any questions, do you? Effective Questioning versus 19
  20. 20. Teach-Back Reminder Card Keep card with you to refer to for Teach-Back 20
  21. 21. Demo and Practice • Teach your partner how to use the call light (less than a minute) • Use Teach-Back card to remind you of the steps: 1. Teach concept 2. Take responsibility 3. Ask for Teach-Back in own words 4. Ask for questions • Switch roles 21
  22. 22. When Teach-Back isn’t used… From House, M.D., Episode #511, Joy to the World, Fox Network 22
  23. 23. What questions do you have? Kelly Pick MSN, RN-BC NPD Patient and Community Health Education PeaceHealth Southwest Medical Center 23
  24. 24. References and Further Reading 5 Million Lives Campaign. (2008). Getting started kit: Improved care for patients with congestive heart failure how-to guide. Cambridge, MA: Institute for Healthcare Improvement. (Available at The Advisory Board Company. (2011). Innovating on 'teach-back' to prevent avoidable readmissions. Retrieved from The Advisory Board Company. Brach C., Dreyer, B., Schyve, P., Hernandez L.M., Baur, C., Lemerise, A. J., Parker, R. (2012). Ten attributes of health literate health care organizations. Institute of Medicine Roundtable on Health Literacy. Retrieved from: http:// Centers for Disease Control and Prevention (2009). Simply put: A guide for creating easy-to-understand materials. Third Edition. Atlanta, GA. Retrieved from DeWalt D. A., Callahan, L.F., Hawk, V. H., Broucksou, K. A., Hink, A., Rudd, R., & Brach, C. (April 2010). Health Literacy Universal Precautions Toolkit. Rockville, MD: Agency for Healthcare Research and Quality. AHRQ Publication No. 10-0046-EF. Retrieved from Fidyk, L., Ventura, K. & Green, K. (2014). Teaching nurses how to teach: Strategies to enhance the quality of patient education. Journal for Nurses in Professional Development, 30(5): 248-253. Healthcare Benchmarks and Quality Improvement. (December, 2010). Readmission rates for HF reduced by 30%. Volume 17(12), p.137-138. Retrieved from %20Library/HBQI-December2010.pdf 24
  25. 25. In Focus: Topics in Health Care Ethics (April, 2006). Teach back: A tool for improving provider patient communication. National Center for Ethics in Health Care. Institute for Healthcare Improvement (2008). Good heart failure care follows patients home. Cambridge, MA: Institute for Healthcare Improvement (Available at Institute of Medicine (2004). Health literacy: A prescription to end confusion. Washington DC: The National Academies Press. Kripalani, S., Bengtzen, R., Henderson, L.E., & Jacobson, T. A. (2008). Clinical research in low-literacy populations: Using Teach-Back to assess comprehension of informed consent and privacy information. IRB: Ethics and Human Research. March-April, pp.13-19. Kutner, M., Greenberg, E., Jin, Y., & Paulsen, C. (2006). The Health Literacy of America’s Adults: Results From the 2003 National Assessment of Adult Literacy. U.S. Department of Education. Washington, DC: National Center for Education Statistics. (NCES 2006–483) London, F. (2009) No time to teach: The essence of patient and family education for health care providers. Atlanta, GA: Pritchett & Hull. National Quality Forum (2010). Safe Practices for Better Healthcare – 2010 Update. Retrieved from 3_2010_Update.aspx 25
  26. 26. Osborne H. (2011). In other words...Confirming understanding with the Teach-Back Technique. Health Literacy Consulting. Retrieved from Press, V., Arora, V., Shah, L., Lewis, S., Charbeneau, J., Naureckas, E., & Krishnan, J. (2012). Teaching the use of respiratory inhalers to hospitalized patients with asthma or COPD: A randomized trial. Journal of General Internal Medicine, 27(10), 1317-1325. Sandberg, E., Sharma, R., & Sandberg, W. (2012). Deficits in retention for verbally presented medical information. Anesthesiology, 117(4), 772-779. Schillinger, D., Piette, J., Grumbach, K., Wang, F., Wilson, C., Daher, C., … Bindman, A. B. (2003). Closing the loop: Physician communications with diabetic patients who have low health literacy. Archives of Internal Medicine; 163:83–90. US Department of Health and Human Services. (2010). Health literacy. Retrieved from Weiss, B.D. (2007). Health literacy and patient safety: Help patients understand, manual for clinicians, Second edition, A Continuing Medical Education opportunity. Date of most recent activity review April 2009. Chicago, IL: American Medical Association Foundation and American Medical Association. 26