just-in-time education for staff nurses about teaching patients about chf
DESCRIPTION
Pamphlet for just-in-time work place education.TRANSCRIPT
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).
Keep reading to learn your
role in reducing heart fail-
ure readmissions.
The Transitions of Care
Team began working with the
Multidisciplinary Heart Failure
Team a few months ago to
develop standardized pro-
cesses around patient educa-
tion for heart failure patients.
The Transitions of Care
Team is the same team that
helped us successfully imple-
ment transition huddles to
facilitate the coordination of
discharge planning.
Why Heart Failure?
The Affordable Care Act es-
tablished the Hospital Read-
missions Reduction Program,
which requires CMS (Centers
for Medicare and Medicaid
Services) to reduce payments
to hospitals with excess read-
missions, effective for dis-
charges, beginning on Octo-
ber 1, 2012.
Readmission is defined as an
admission to a hospital within
30 days of a discharge from
the same or another hospital.
Health Care Reform
Heart Failure Education
Transitions of Care Project
S P E C I A L
P O I N T S O F
I N T E R E S T :
Health Care Reform
Transitions of Care
Project
Bull’s Eye
Teach Back
Contributors: Shelly
Padgett, Pam Bruce, Melis-
sa Powell, Brittany Cun-
ningham
P A G E 2
-Institute for Healthcare
Improvement
Caption describing
picture or graphic.
How do we reach the AIM?
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
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 pro-
cess—VHVI Bedside Nurses
Develop a plan for the Heart Failure Bullseye: The
admitting nurse will hang the Heart Failure Bullseye in every patient room ad-
mitted with Heart Failure. The tool should hang below the whiteboard in the
patient’s room. This initiative starts 7/9/13.
3. Set Clear Roles and Expectations
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.
Define which patients receive the bifold v. the book
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 feed-
back.
5. Expand PEER out of the pilot phase to see patient progression across the continuum.
PEER Version 2 is currently being built
Staff education on PEER Version 2 being planned
After implementation, the leadership team is to incorporate teaching record
audits into daily Quality Huddles.
H E A R T F A I L U R E
E D U C A T I O N
T R A N S I T I O N S O F C A R E
7N Team Members
involved in this pro-
ject:
Cayce Ake
Kristen Bartlett
Erin Bucha
Greg Harrington
Rita Hayle
Mara Hutchings
Leslie Sigler
What is the Heart Failure Bull’s Eye about? P A G E 3
The Heart Failure Bull’s Eye is
about engaging the patient as
well as the health care provider.
The goal is to have every health
care team member addressing
the bull’s eye when they enter
the patient’s room.
RN
MD during rounds
Case Manager
Transition Care Coordina-
tor
Pharmacist
Nutritionist
Education is done by the multi-
disciplinary team. We each
have a role to do.
The ultimate goal is to see the
patient progress toward the
center of the bull’s eye.
Red: We provide the edu-
cation.
Yellow: We assess their
knowledge of the education
through the principles of
teach back.
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
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.
Each
healthcare
provider
will fill in
a heart
when the
patient
meets that
goal.
Bull’s Eye in pa-
tient’s room
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.
“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
Use a caring tone of voice and atti-
tude.
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 empa-
thy and caring.
Use humor.
Creating psychological safety is im-
portant.
Circle important points on handouts.
Draw pictures as needed.
Teach Back Is the Only Way We Know for Sure
Elements of Good Patient Teaching Patient Safety
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.
Why don't we use it?
We think we are already doing it.
We don’t think we need to do it. We make
assumptions that clearly the patient “gets it.”
The patient is smiling and nodding appropriate-
ly and they said they don’t have any questions.
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
the patient does or does not understand.
Fast food restaurants do it well at the drive thru
window. Why can’t we?
Key Points:
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 mov-
ing on to the next concept.