El Camino Hospital uses staff training, videos, and peer review to teach teach-back.
We heard from patients during follow-up calls or home visits that they were confused about how to take their medication or manage their condition after discharge. Even though we were providing education, it clearly wasn’t enough. It’s not about the patients’ intelligence or education level, it’s about you teaching the patients. It’s especially important to take this into account as many patients are elderly, frail, may have cognitive impairment, and/or a language barrier.
Studies show that a high percent of medical information received by patients is forgotten immediately or retained incorrectly. Teach-back is a method of communication that allows the person doing the teaching to confirm that the patient (or family/caregiver) understands. We knew teach-back was a proven method for teaching patients, but it’s not as easy as just telling staff to use it. It takes practice to do teach-back well and we wanted to prepare our nurses appropriately.
El Camino is a non-profit hospital in Mountain View, CA. It has 399 beds and serves a primarily affluent and educated population, many of who are non-English speaking or have English as a second language. Their transitions program began in 2012 and is influenced by the Care Transitions Program.
What We Tried
We developed a training program for nurses to become competent in using teach-back methodology for all patient teaching. We began with one unit, then spread this to all nurses in medical units, and have now opened the training up to all of our staff. The training consists of an online module that includes a video of proper teach-back that we found online (https://www.youtube.com/watch?v=pCNCqA5LqFo). The module takes about 20-25 minutes to complete. After completing the module, the nurses do a peer review with their department educator or “super-user” (someone who has been pre-approved as a teach-back expert). The educator or expert watch the nurse performing teach-back with a patient and certify them if they do it well.
Our patients see a lot of staff during their stay. Now, all or most of them are equipped to educate the patient on his or her disease, medication, or discharge instructions. Within two months of rolling out the teach-back training, our HCAHPS score around medication and side effects have improved significantly. If patients better understand how and why to take their medications, there is a smaller chance of them being readmitted.
It was important for us not to add to our nurses’ workload unnecessarily. We worked with each department to determine whether the nurses could receive education hours for the training and made sure they had permission to take the training while at work.
Since our training included videos, we had to work with the IT department to identify computer stations where they could watch the videos. We also asked the nurses to bring headphones so that they didn’t disturb other staff.