The document discusses a heart failure education transitions of care project at VUMC. It aims to develop standardized processes for heart failure patient education across care settings using consistent tools and content. This includes developing standardized educational materials located in a central area, defining reliable processes involving key stakeholders, and delivering evidence-based education using teach back principles. The project uses a "Heart Failure Bull's Eye" tool to engage patients and assess their understanding, with the goal of progressing them toward self-care. Teach back is emphasized as the best way to ensure understanding, and elements of effective patient teaching are outlined.

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. 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. 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. 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