Teach Back
Improving Patient Education
Janet Grace, RN, BSN
Saline Memorial Hospital
Objectives
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Define teach-back and its purpose
Describe the key elements for using
teach-back correctly
Apply in the clinical setting
The Challenge
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40-80% of medical information
patients receive is forgotten
immediately and nearly ½ of the
information retained is wrong.
The Challenge
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A common quote states we retain:
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10%
20%
30%
50%
70%
80%
95%
of
of
of
of
of
of
of
what
what
what
what
what
what
what
we
we
we
we
we
we
we
read
hear
see
see and hear
discuss with others
experience
teach to someone else
Printed Discharge Instructions
Your naicisyhp has dednemmocer that
you have a ypocsonoloc. Ypocsonoloc
is a test for noloc recnac. It sevlovni
gnitresni a elbixelf gniweiv epocs
into your mutcer. You must drink a
laiceps diuqil the thgin erofeb the
noitanimaxe to naelc out your noloc.
What it Says….
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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?
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There is a policeman in an unmarked
car going up and down highway 78
handing out tickets.
The Right to Understand
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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
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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
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Always:
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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?
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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, reteach the information
Why Use Teach-Back?
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Improves the ability to assess understanding of
teaching
Allows feedback & corrections of misunderstandings immediately
Increases patient’s confidence in providing selfcare
Encourages active patient/family participation
Improves the transition from hospital to home
Improves the overall safety and quality of care
Confirming Understanding
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Ask patients to acknowledge
understanding using their own words.
Examples:
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“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
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“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
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Teach back provides the opportunity to
confirm understanding BEFORE adding any
new information.
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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
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Do NOT ask yes/no questions like:
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“Do you understand?”
“Do you have any questions?”
For more than one concept “Chunk and
Check”:
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Teach the 2-3 main points for the first concept &
check for understanding using teach-back.
Then go to the next concept.
Teach Back Method
Uses 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
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“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
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
 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
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When communicating follow-up
appointment include:
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Place, date, time
Access to transportation
Provider name and specialty
WHY they need to follow-up; be specific
Elements of Competence
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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
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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
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What are specific topics or directions you
commonly discuss with your patient that
you can use the teach-back method with?
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Ideas: insulin injections, medications, chronic
disease self-care, etc.
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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 positive
 Utilizes plain language for explanations
 Does NOT ask patient, “Do you understand?”
Acknowledgements
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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