Striving for Patient Centered Education: A Nursing Teams Journey to Implement Teach-Back in an Urban Acute Care Hospital

Purpose:
The American Medical Association identifies poor health literacy as "a stronger predictor of a person's health than age, income, employment status, education level, and race." Untoward results include excess hospitalizations, missed appointments, medication errors, and misinterpreted instructions.

Significance:
Patient Centered Education (PCE) improves access, understanding and application of knowledge acquired during acute care admissions. Teach-Back is a patient-centered approach for confirming comprehension of critical self-care activities to help ensure safety and quality care pre and post discharge.

Strategy and Implementation:
Implementing Teach-Back began with the Clinical Nurse Facilitator, who is a master's prepared generalist with experience in evidence based practice programs, team building and quality improvement. During the initial phase, a literature and resource review was completed including a National Quality Forum report that identified teaching back as one of 50 essential “safe practices” to improve health care and improve efficiency in clinical practice. Our interdisciplinary team planned strategies for classroom education, poster development, just-in-time follow-up training and evaluation. Nurses received video, written, verbal and hands on training in Teach-Back. Medication reconciliation was the primary focus and included patient teaching on right medication, right time, right amount and medication side effects. Teach back emphasizes using language that is easily understood, maintaining eye contact, clear speech and allowing time for patients to repeat the information in their own words.

Evaluation:
For an extensive overview, PCE program implementation occurred on 3 nursing units with data analyzed for 6 months. Dimensions of care evaluated were “nursing communication about medication” with rates increased from 80.6% to 87% and “discharge instructions” with rates increased from 84.6% to 92%.

Implications for Practice:
Patients with poor health literacy are less aware of preventive health methods, less knowledgeable of medical conditions and limited in self care skills. Offering clear, concise patient education yields benefits including decreased anxiety and pain, better compliance and improved symptom resolution.