Presented by Kelly Pick, MSN, RN-BC NPD, on March 13, 2015 at the fifth Center for Health Literacy Conference: Plain Talk in Complex Times.

1. Teach-Back: Make Sure they Understand
Kelly Pick MSN RN-BC NPD
Patient and Community Education
PeaceHealth Southwest Medical Center

2. Last Trip to that Store
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3. Who needs Teach-Back?
employee colleague
child
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4. Key Resources
AMA Health Literacy and Patient Safety: Help Patients
Understand. Manual for Clinicians, Weiss et al. (2007)
AHRQ Universal Precautions Toolkit, DeWalt, et al. (2010)
Always Use Teach-back! Training Toolkit, AMA, Picker Institute,
UnityPoint Health, Des Moines University, et al. (2014)
http://www.teachbacktraining.org/
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5. Health Literacy
Weiss, B.D. (2007) 5

6. …for Low Health Literacy
• Can’t tell by looking
• Communicate clearly with everyone
• Confirm understanding with everyone
Universal Precautions…
DeWalt, et al. (2010) AHRQ Universal Precautions Toolkit 6

7. Clear Communication
• Slow down
• Use plain, non-medical language
“living room language”
• Show or draw pictures
• Create a shame-free environment
• Use Teach-Back
Weiss, B. (2007) 7

8. Teach-Back: What is it?
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9. How does Teach-Back help?
Health Care
• Patient safety
• Patient engagement and
satisfaction
• Reduces:
–unnecessary clinic visits
–emergency room visits
–hospital re-admissions
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Business/Government/Education
• Provides clarity
• Improves customer/constituent
satisfaction
Family and Friends
• Better relationships
All: Quick and easy way to assess understanding

10. “I don’t have time”
Studies and Pilot Projects
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Start small:
• One patient encounter per day (last visit)
• Work up to more as you get more
comfortable
• Practice at home

11. Key Learner
Identify and involve as much as possible
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12. Need-to-know versus Nice-to-know
Needs Assessment
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13. A Physician’s Experience
www.teachbacktraining.org 13

14. Chunk ‘n Check
…if more than 2-3 points
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15. Knowledge: Can you tell me how much insulin
you should give yourself every day?
Attitude: Do you know why it’s important for
you to take your Lasix every day?
Behavior: How do you plan to remember to
take all your medicines correctly
every day?
Three Types of Questions:
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16. Avoid yes/no questions
• Do you understand?
• Does that make sense?
• Is that clear?
Check for Understanding
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17. Take Responsibility…
I want to make sure you understand…
Whose fault is it?
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versus
I want to be sure I’ve been clear...

18. Repeat back
Avoid the Parrot
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versus
Teach back in your own words

19. What questions do you have?
You don’t have any questions, do you?
Effective Questioning
versus
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20. Teach-Back Reminder Card
Keep card with you to refer to for Teach-Back
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21. Demo and Practice
• Teach your partner how to use the call light
(less than a minute)
• Use Teach-Back card to remind you of the steps:
1. Teach concept
2. Take responsibility
3. Ask for Teach-Back in own words
4. Ask for questions
• Switch roles
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22. When Teach-Back isn’t used…
From House, M.D., Episode #511, Joy to the World, Fox Network 22

23. What questions do you have?
Kelly Pick MSN, RN-BC NPD
Patient and Community Health Education
PeaceHealth Southwest Medical Center
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24. References and Further Reading
5 Million Lives Campaign. (2008). Getting started kit: Improved care for patients with congestive heart failure
how-to guide. Cambridge, MA: Institute for Healthcare Improvement. (Available at www.ihi.org)
The Advisory Board Company. (2011). Innovating on 'teach-back' to prevent avoidable readmissions. Retrieved
from The Advisory Board Company.
Brach C., Dreyer, B., Schyve, P., Hernandez L.M., Baur, C., Lemerise, A. J., Parker, R. (2012). Ten attributes of health
literate health care organizations. Institute of Medicine Roundtable on Health Literacy. Retrieved from: http://
www.iom.edu/~/media/Files/Perspectives-Files/2012/Discussion-Papers/BPH_HLit_Attributes.pdf
Centers for Disease Control and Prevention (2009). Simply put: A guide for creating easy-to-understand
materials. Third Edition. Atlanta, GA. Retrieved from http://stacks.cdc.gov/view/cdc/11938/
DeWalt D. A., Callahan, L.F., Hawk, V. H., Broucksou, K. A., Hink, A., Rudd, R., & Brach, C. (April 2010). Health
Literacy Universal Precautions Toolkit. Rockville, MD: Agency for Healthcare Research and Quality. AHRQ
Publication No. 10-0046-EF. Retrieved from http://www.ahrq.gov/qual/literacy/index.html
Fidyk, L., Ventura, K. & Green, K. (2014). Teaching nurses how to teach: Strategies to enhance the quality of patient
education. Journal for Nurses in Professional Development, 30(5): 248-253.
Healthcare Benchmarks and Quality Improvement. (December, 2010). Readmission rates for HF reduced by 30%.
Volume 17(12), p.137-138. Retrieved from http://www.henryfordconnect.com/documents/Sladen
%20Library/HBQI-December2010.pdf
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25. In Focus: Topics in Health Care Ethics (April, 2006). Teach back: A tool for improving provider patient
communication. National Center for Ethics in Health Care.
Institute for Healthcare Improvement (2008). Good heart failure care follows patients home. Cambridge, MA:
Institute for Healthcare Improvement (Available at www.ihi.org).
Institute of Medicine (2004). Health literacy: A prescription to end confusion. Washington DC: The National
Academies Press.
Kripalani, S., Bengtzen, R., Henderson, L.E., & Jacobson, T. A. (2008). Clinical research in low-literacy populations:
Using Teach-Back to assess comprehension of informed consent and privacy information. IRB: Ethics and
Human Research. March-April, pp.13-19.
Kutner, M., Greenberg, E., Jin, Y., & Paulsen, C. (2006). The Health Literacy of America’s Adults: Results From
the 2003 National Assessment of Adult Literacy. U.S. Department of Education. Washington, DC: National
Center for Education Statistics. (NCES 2006–483)
London, F. (2009) No time to teach: The essence of patient and family education for health care providers. Atlanta,
GA: Pritchett & Hull.
National Quality Forum (2010). Safe Practices for Better Healthcare – 2010 Update. Retrieved from
http://www.qualityforum.org/Publications/2010/04/Safe_Practices_for_Better_Healthcare_%e2%80%9
3_2010_Update.aspx
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26. Osborne H. (2011). In other words...Confirming understanding with the Teach-Back Technique. Health Literacy
Consulting. Retrieved from http://www.healthliteracy.com/article.asp?PageID=6714
Press, V., Arora, V., Shah, L., Lewis, S., Charbeneau, J., Naureckas, E., & Krishnan, J. (2012). Teaching the use of
respiratory inhalers to hospitalized patients with asthma or COPD: A randomized trial. Journal of
General Internal Medicine, 27(10), 1317-1325.
Sandberg, E., Sharma, R., & Sandberg, W. (2012). Deficits in retention for verbally presented medical
information. Anesthesiology, 117(4), 772-779.
Schillinger, D., Piette, J., Grumbach, K., Wang, F., Wilson, C., Daher, C., … Bindman, A. B. (2003). Closing the
loop: Physician communications with diabetic patients who have low health literacy. Archives of Internal
Medicine; 163:83–90.
US Department of Health and Human Services. (2010). Health literacy. Retrieved from
www.health.gov/communication/literacy/quickguide/factsbasic.htm
Weiss, B.D. (2007). Health literacy and patient safety: Help patients understand, manual for clinicians, Second
edition, A Continuing Medical Education opportunity. Date of most recent activity review April 2009.
Chicago, IL: American Medical Association Foundation and American Medical Association.
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