Striving for Patient Centered Education: A Nursing Teams Journey to Implement TeachBack in an Urban Acute Care Hospital
Myra L Couch, MSN, RN-BC, CNL, Mary Rudy, MN, RN, NEA-BC, Ellesha McCray, MBA, MSN, RN,
NE-BC, Darlene Dietrich, MBA, MSN, RN, Roseanne Zawinski, MSN, RN-BC, Kelly White, MSN, RNBC
Veterans Administration Pittsburgh Healthcare System
Pittsburgh, PA
Email: myra.couch@va.gov
Background : U.S. Department of Health and Human Services (HHS) defines health literacy as
the degree to which individuals have the capacity to obtain, process, and understand basic health
information and services needed to make appropriate health decisions. The HHS reports that
nearly nine out of ten adults may lack the literacy and numeracy skills needed to manage their
health and prevent disease. Low literacy has been linked to poor health outcomes, increased
likelihood of having chronic conditions which patients are less able to manage, higher rates of
hospitalization and excessive usage of emergency services as opposed to preventive care.
Aim: Teach-Back is a patient-centered approach for health education which stresses the
importance of confirming comprehension of all critical self-care activities. To improve patients
understanding of their medications and common side effects, and to increase effectiveness of our
discharge process, Teach Back was implemented as standard practice for patient teaching on all
inpatient acute care units. Teach Back allows nurses to consistently offer clear, concise
instructions as we strive to improve patient knowledge and satisfaction as determined during
follow-up discharge phone calls.
Methods/Programs/Practices: Implementation of Teach-Back was initiated by the Clinical
Nurse Leader (CNL), with full support of the Chief Nurse Executive. The CNL is a master's
prepared generalist with experience in evidence based practice programs, team building and
quality improvement. The literature and resource review included a recent 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, lead by the
CNL included nurse managers and nurse educators working collaboratively to plan 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. The American Medical
Associations Clinician’s Manual titled “Health Literacy and Patient Safety: Help Patients
Understand, was chosen as our primary teaching resource. Medication reconciliation was the
primary focus and included patient teaching on right medication, right time, right amount,
medication side effects and appropriate responses to adverse events. Teach Back training
emphasized reducing the tendency to ask closed ended question like “Do you understand?,"
provides time for verification of patient comprehension, and promotes using easily understood
plain language. Most importantly, Teach Back creates a dialogue between professionals and
patients by allowing time for patients to repeat the information in their own words and if needed
receive additional teaching. Implementation followed the Plan-Do-Study-Act process. After
studying staff and patient responses, plans were updated to include Teach Back in new nursing
orientation and as an annual nursing competency beginning in 2013.
Outcome Data: Implementation of the Teach Back initiative has spread to 3 nursing units with
data analyzed for the past 9 months. Dimensions of care evaluated were “nursing communication
about medication” with rates initially increased from 80.6% to 87% and “discharge instructions”
with rates increased from 84.6% to 92%. The inpatient acute care units continue to now meet
expected goals and show sustainable improvement in these metrics. Please see attached graph.
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Apr-12
Mar-12
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11-Oct
Teach Back
Outcomes
BLUE=Communication at Discharge
RED=Medication Comprehension