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Performance and Quality ImprovementThe Preventing READMISSIONS Project: An Update for RNsSituationContinuation of Highmark Quality Blue Pay for Performance Project started in July 2012We can help to prevent unnecessary readmissions by better preparing our patients to take care of themselves after discharge 2012-13 focus: improved electronic Discharge Instructions & timely transmission of the transition record to the facility or healthcare professional designated for follow-up careRevisions to the e-DC Instructions ongoing; the strides we’ve made have already helped to improve legibility, communication to the next providers of care, and has received positive feedback from receiving physicians and outside institutions 2013-14 focus: making sure our patients understand what we teach themBackground Goal: The hospital works to reduce 7-day and 30-day readmission rates through adequate patient preparation for self-care after discharge This is accomplished by assessing the patient’s Health Literacy on admission and as needed, and providing the patient with a comprehensive teaching plan inclusive of an evaluation of the patient’s/family’s understanding (readiness for care after discharge)Assessment The good news: Whether you realize it or not, you (RNs) are already doing Health Literacy assessments! What exactly is Health Literacy? Health Literacy is the patient’s ability to get the health information s/he needs, and to understand it. It is also about using the information to make good decisions about his/her health and medical care. The facts:Many people have trouble understanding information about their health. Low health literacy can cause harm. About 9 out of 10 American adults have some problems with health literacy.The required components:Health Literacy Assessment on admissionCare Plan – every patient needs a “Knowledge Deficit” care planPatient Teaching – document use of Teachback and education response/effectiveness The above 3 components MUST be documented every patient, every timeContinue completion of electronic DC InstructionsRecommendationsReview project with RNs and providers who impact the patient education processHighlight the areas of documentation which can significantly impact our patients’ outcomes:Health Literacy Assessment (Teaching > Barriers > ? barriers)Care Plan – every patient minimally needs a “Knowledge Deficit” care planPatient Teaching – every patient, every timeRN needs to use the Teach Back method Teaching done & documented RN evaluates the patient learning experience (effectiveness)Reminders:Time is valuable…make it meaningful for patients. Connect-the-dots.SLUHN implemented Teachback as the preferred method for patient education as of 9/1/2013Teaching screens have been updated to reflect teach-back as a methodologyReview of Teach-back MethodEffective patient teaching takes a patient-centered approach (i.e. Teach-back)Teach-back is a simple method used to evaluate a patient’s understanding of a concept or topicTeach-back begins once the initial training on the subject is completed Tell the patient you want to be sure that you did a good job Ask the patient to explain what s/he has learned in his own words Start by training the patient on only 2 or 3 basic concepts so as to not overwhelm the patientTraining needs to begin early in the patient stay so that concepts can be reviewed and learning achieved in a layered approach instead of all at once at the time of discharge The Teach-back process can help you evaluate what the patient understands or does not understand so you know where to focus your teachingAvoid questions that require yes/no answersAsk open ended questions (encourages the patient to explain what has been learned)Give the patient the time s/he needs to explain (Rushing raises the anxiety level in the room and interferes with learning)Use simple terms - 5th grade level or less - without being patronizing Document your evaluation as well as progress/plan of care for concepts which still need to be coveredNeed more information about Teach-back? MyNET > Learning tab > Tracker Trainer > Patient Education using the Teach-back MethodGo on to next page…ExampleMrs. Smith is a 75-year-old just admitted with exacerbation of COPD. This is her third admission in the last 90 days. As the RN, you know that she needs be able to manage her disease safely at home.What needs to occur at the time of initial assessment? The RN needs to: assess Mrs. Smith’s health literacy, develop a care plan that addresses teaching needs, evaluate her knowledge of her disease process, and start patient teaching. Health Literacy AssessmentAssess her health literacy (learning barriers) > What is her education level? Does she read? Can she describe her disease?The RN learns that Mrs. Smith attended school only through 8th grade. She is reluctant to talk about her education and quickly changes the subject. The RN identifies the following health literacy issues that may impact her understanding of how to manage her disease: she lives alone, has only an 8th grade education, and cannot really describe COPD other than to say she has a breathing problem. Where does the RN document this assessment? Teaching screen > Barriers > ?literacy/education (the RN could also annotate the education level)The RN knows that a care plan is needed related to her learning needs.Care PlanThe RN initiates a care plan that will address that Mrs. Smith does not understand how to manage her COPD. Subsequent RNs need to update the care plan as Mrs. Smith’s understanding improves. DocumentKnowledge Deficit, Teaching (learning needs related to disease process, self-management, medications)Target outcomes – Disease process Progress > Outcomes> level understandingPatient EducationThe RN provides a basic description of COPD verbally and gives Mrs. Smith a copy of COPD information from Krames (written at a 5th grade reading level).Later that shift, the RN wants to evaluate how much Mrs. Smith remembers about COPD. Using the Teach Back method which builds on a patient’s learning, the RN can evaluate what Mrs. Smith has learned thus far. “I want to be sure I did a good job reviewing what COPD is. Can you tell me in your own words what COPD is?”The RN then listens carefully as Mrs. Smith describes COPD and provides appropriate feedback regarding the accuracy of the description filling in any gaps. “You remembered quite a bit about your disease. Let’s talk about how to use your inhaler.”DocumentDocumentation needs to reflect how the RN attempted to meet Mrs. Smith’s health literacy needs. Documentation also must include how teaching was provided and the effectiveness of that teaching.Teaching screen > Disease Process (?explain dx, ?verbal, ?handout)Teaching screen > Teachback used > (yes or no)To document the effectiveness of the teaching topic provided to Mrs. Smith, the RN documents patient response, teaching effectiveness, etc. in the appropriate teaching screen.The screen shots that follow provide an example of how the RN might document the key points of Health Literacy, Teachback, and Care Planning.Teaching:Barriers:5334001183005001316355014097007353310Teachback used:523876149606000476251229360013906507054850Disease Proc:5715002172335001324610014192257721600Careplan:600075160083500476252562860008286757912100Target Outcomes:638175154432000762012525395008667757632700Prog>>Outcome:581025174371000476262791460008191508769350You have completed the program: Preventing READMISSIONS Project: An Update for RNsPlease exit this page and “Take Test”. ................
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