Pennsylvania Hospital Engagement Network Achieving More Together. PA-HEN Preventable Readmission Collaborative Training Sessions Fall 2013

Transcription

1 Pennsylvania Hospital Engagement Network Achieving More Together PA-HEN Preventable Readmission Collaborative Training Sessions Fall 2013

2 Health Literacy The degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions. (Ratzan and Parker, 2000) Functional health literacy is the ability to apply reading and numeracy skills in a health care setting. 2

3 Health Literacy General literacy. Experience with health system. Complexity of information. Cultural and language factors. How information is communicated. Aging. 3

4 General Literacy Below Basic = 30 million people. Basic = 63 million people. Intermediate = 95 million people. Proficient = 28 million people. Use it or lose it! Average adult reads 3-5 grade levels below highest grade completed. 4

5 Health Literacy These are our patients l7lg8&feature=related 5

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7 How do you clean the capstan? Can you answer this question? Why are you having trouble answering the question? 7

8 Red Flags Incomplete registration forms. Frequently missed appointments. Medication non-compliance. Lack follow through with tests, x-rays, or referrals. Unable to name medications, or explain purpose or timing of administration. State that I forgot my glasses or ask to read at home. No reading materials. Has no questions. Fake understanding Superior memorization. 8

9 Routine Screening for Health Literacy???? Possibility to identify at-risk patients Controversial Potential for patient harm. Miss those that do not have literacy issues. Screening often not recommended. Universal Precautions. 9

10 AHRQ Toolkit 10

11 What to do??? Ask me 3 ; What is my main problem? What do I need to do? Why is it important to me to do this? Partnership for Clear Communication,

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13 The single biggest problem in communication is the illusion that it has occurred. George Bernard Shaw

14 TEACH-Back Asking that patients recall and restate what they have been told is one of 11 top patient safety practices based on strength of scientific evidence. (AHRQ, 2001 Report on Making Health Care Safer) 14

15 TEACH-Back Explain Assess Clarify Understanding 15

16 Frequent System Failures Assuming the patient is the key learner. Failure to ask clarifying questions about instructions and plan of care. Providing written discharge instructions that are confusing, contradictory to other instructions, or not tailored to a patients level of health literacy or current health status. 16

17 Understand Processing Demands Stress. Illness & medications. A lot of information; limited time. Noise-levels and general hub-bub. Divided attention. Demands can be compounded by fatigue, discomfort or anxiety % of medical information provided by practitioners is forgotten immediately. 17

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19 Teach-Back Triad What Meaningful Conversation Why Process How 19

20 Conversational TEACH-Back Using Teach-Back conversational questions We have gone over a lot of information; what have we discussed? How will you make it work at home? Can you let me know what you heard me say? What will you tell your spouse about your condition? What do you think will work best for you at home? I want to make sure I explained it correctly. Can you tell me in your words how you understand the plan? or tell me how you will take your medications? 20

21 How to Teach Ask patients and families how they learn best. Slow down when speaking to the patient and caregivers. If written materials are used highlight don t use underline. Avoid duplicate paperwork. Match terminology in written materials, to what is taught or provided elsewhere. Use plain language, eliminate medical jargon. 21

22 Word Substitutions Handout to use. c/info/plain_language_thesaurus_for_he alth_communications.pdf 22

23 Uncommon Words Concept Words Keep your glucose level within the normal range. Add an example to clarify its meaning: This means to keep your blood sugar somewhere between 70 and 120; that is the range of sugar numbers that means your blood sugar is normal that it s okay. Value Judgment words Clarify what words such as heavy, regularly, and excessive mean. 23

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25 Using TEACH-Back Use multiple opportunities to teach during hospitalization. Use TEACH-Back as both a teaching and diagnostic tool. Pass along to clinicians in the next site of care any patient or caregiver struggles with TEACH-Back. IHI conference,

26 Incorporating with Workflow Work to include this in your existing care plans. Add to shift report. Include all members of the team. Decide on the 3-5 most important items to teach as part of the plan and revise as necessary. Start on day one. 26

27 Practice The patient has developed an infection after having the gall bladder removed and needs to learn how to change her bandages and care for the infected area. 27

28 Dr: Mr(s) Garcia, it appears that you have developed an infection at the incision sight when we excised your gall bladder. You will need to perform multiple daily dressing changes using sterile technique until the wound closes 28

29 Practice The patient has just been diagnosed with diabetes and needs to start monitoring her blood sugar levels and taking insulin. The GTT is a test that tells you how well your body is breaking down sugar. Type one diabetes means that the pancreas no longer produces insulin. 29

30 Practice DR: After reviewing your GTT results it has been determined that you have type 1 diabetes mellitus. This means that you will have to start monitoring you glucose level using a glucometer and giving yourself multiple insulin shots every day. 30

31 Take Homes Keep language simple use living room language. Limit teaching to the top 3-5 things. Use Teach-back methodology and Triad. Teach from the first day, using all opportunities for small teaching moments. Add teaching to shift change report. 31

32 Questions 32

33 Thank You Thank you to SEPA-READS and Jefferson University for their assistance. For addition questions and assistance please contact: Cindy Hipszer, Project Manager PA-HEN