Teach Back

Improving Patient Education

Janet Grace, RN, BSNSaline Memorial Hospital

Objectives

Define teach-back and its purpose

Describe the key elements for using teach-back correctly

Apply in the clinical setting

The Challenge

40-80% of medical information patients receive is forgotten immediately and nearly ½ of the information retained is wrong.

The Challenge

A common quote states we retain: 10% of what we read 20% of what we hear 30% of what we see 50% of what we see and hear 70% of what we discuss with others 80% of what we experience 95% of what we teach to someone

else

Printed Discharge Instructions

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is a test for noloc recnac. It sevlovnignitresni a elbixelf gniweiv epocsinto your mutcer. You must drink alaiceps diuqil the thgin erofeb thenoitanimaxe to naelc out your noloc.

What it Says….

Your physician has recommended that you have a colonoscopy. Colonoscopy is a test for colon cancer. It involves inserting a flexible viewing scope into your rectum. You must drink special liquid the night before the examination to clean out your colon.

What does this mean?

There is a bear in a plain wrapper doing flip flops on 78 handing out green stamps.

What does this mean?

There is a policeman in an unmarked car going up and down highway 78 handing out tickets.

The Right to Understand Patients have the right to understand

healthcare information that is needed for them to safely care for themselves

Healthcare providers have a duty to provide information in a simple, clear, and plain language AND to check that the patients have understood the information

Universal Communication Principles

Everyone benefits from clear information

Many patients are at risk for misunderstanding but it is difficult to identify them

Knowing the patient’s level of education does not ensure patient understanding

When Communicating with Patients and Families

Always: Use plain language Slow down Break it down into short sentences Focus on the 2 or 3 most important

concepts Check for understanding using teach-

back

What is Teach Back? Teach back is asking patients to

repeat in their own words what they have learned

It is not a test of the patient, but of how well YOU explained the concept

It is a chance to check for understanding and, if necessary, re-teach the information

Why Use Teach-Back? Improves the ability to assess

understanding of teaching Allows feedback & corrections of mis-

understandings immediately Increases patient’s confidence in

providing self-care Encourages active patient/family

participation Improves the transition from hospital to

home Improves the overall safety and quality of

care

Confirming Understanding

Ask patients to acknowledge understanding using their own words.

Examples: “I want to be sure I explained

everything clearly. Can you please explain it back to me so I can be sure I did?”

Confirming Understanding “What will you tell your husband about

the changes that were made to your blood pressure medicines today?”

“We’ve gone over a lot of information, a lot of things you can do to get more exercise in your day. In your own words, please review what we talked about. How will you make it work at home?”

Confirming Understanding Teach back provides the opportunity to

confirm understanding BEFORE adding any new information. Re-phrase the information IF the patient is

unable to repeat the information accurately.

Ask them to repeat the information again using their own words.

Repeat the process until you are comfortable they really understand it.

If they still don’t understand it then consider other strategies.

Closing the Loop

Teach-back Additional Points Do NOT ask yes/no questions like:

“Do you understand?” “Do you have any questions?”

For more than one concept “Chunk and Check”: Teach the 2-3 main points for the first

concept & check for understanding using teach-back.

Then go to the next concept.

Teach Back MethodUses statements such as:

“I want to make sure I explained everything clearly to you. Can you please explain it back to me in your own words?”

OR “I want to make sure I did a good job

explaining this to you because it can be very confusing. Can you tell me what changes we decided to make and how you will take your medicine now?”

If needed, clarify and reinforce the explanation to improve patient understanding.

Teaching the Topic

The signs of heart failure: Dyspnea on exertion Weight gain from fluid retention Edema in your lower extremities and

abdomen Fatigue Dry, hacky cough Difficulty breathing when supine

Teaching the Patient

I am going to talk to you about the signs of heart failure. The signs of heart failure are:• Shortness of Breath• Weight gain from fluid build-up• Swelling in feet, ankles, legs or stomach• Dry, hacky cough• Feeling more tired, no energy• It’s harder for you to breath when lying

down

Teaching the Patient I’m going to talk to you about what you need to

do every day at home to control your heart failure. Every day:Weigh yourself in the morning before breakfast and

write it downTake your medication the way you shouldCheck for swelling in your feet, ankles, legs and

stomachEat low-salt foodBalance activity and rest periods

List four things for me that you are going to do everyday

What’s wrong with this? Shouldn’t be like a test.

Teaching the Patient – Teach Back Method

I’m going to talk to you about what you need to do every day at home to control your heart failure.” Every day:• Weigh yourself in the morning before breakfast and

write it down• Take your medication the way you should• Check for swelling in your feet, ankles, legs and

stomach• Eat low-salt food• Balance activity and rest periods

I teach people about this every day, and sometimes I go over it quickly or may not make myself clear. I want to make sure you know what you need to do. So, can you tell me some things you will do each day?

Discharge Info

When communicating follow-up appointment include: Place, date, time Access to transportation Provider name and specialty WHY they need to follow-up; be

specific

Elements of Competence Responsibility is on the provider Use a caring tone of voice and attitude Use PLAIN language Ask the patient to explain using their

own words – NOT yes/no Use for all important patient

information, specific to the condition Document use of & response to teach-

back.

Other Without teach-back the only indicator of

misunderstanding may be a medication error.

You might be surprised at the misconceptions patients have about their discharge instructions.

Nonverbal cues are not always reliable. Include caregivers when giving

discharge instructions- using Teach Back.

Questions to Consider

What are specific topics or directions you commonly discuss with your patient that you can use the teach-back method with? Ideas: insulin injections, medications,

chronic disease self-care, etc. Inadequate knowledge of insulin, oral

hypoglycemics and anticoagulants are common reasons for readmission

Practicing Teach Back Method

Each participant will participate in a role-play providing education to a patient. The following will be assessed:Ability to do teach back in a shame-free way,

e.g. tone is positiveUtilizes plain language for explanationsDoes NOT ask patient, “Do you understand?”

Acknowledgements

The Iowa Health System Health Literacy Collaborative

Santa Clara Valley Medical System in collaboration with Educational Services at Children’s Hospital of WI – 2010

www.nchealthliteracy.org http://www.ahrq.gov

Practice Teach Back