HRET HIIN Falls Event Teach-Back for Falls Safety: Beyond Checking the Box May 11, 2017 1
Welcome and Introductions Erin Craig, MPA Senior Program Manager HRET 2
Upcoming Events HRET HIIN Rural/CAH Event: Get on Track with Antibiotic Stewardship Monday, May 15, 2017, 1-2pm CT Register HRET HIIN Leadership Event: Huddle Up for Safety Thursday, May 18, 2017 11am 12pm CT Register HRET HIIN PFE Fundamentals: Session #3: Preparing Patient and Family Advisors: Orientation? Tuesday, May 23, 2017 11am 12pm CT Register View all upcoming events 3
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2017 Falls with Injury Change Package Falls with Injury Change Package Falls Top Ten Checklist 5
Agenda for Today 1:00-1:05 p.m. Welcome and Introductions 1:05-1:10 p.m. HIIN Falls Data Resources and Update Preview HIIN Falls data collection fact sheet and hear an overview of our data submission progress. 1:10-1:30 p.m. Honoring the Patient s Autonomy and Independence Erin Craig, MPA Senior Program Manager, HRET Mariana Lesher, MS Data Analyst, HRET Explore the nurse s ethical role in supporting a patient s informed decision making and independence while in the hospital. Move beyond labeling patients as non-compliant to discover techniques that engage patients in safety by linking consequences to their choices. Patricia Quigley, PhD, ARNP,CRRN, FAANP Nurse Consultant 1:30 1:45 p.m. Hospital Story Learn from a HIIN fellow how patient and family engagement has been adopted as a successful strategy to reduce injurious falls. 1:45 1:55 p.m. How to Make Teach-Back Stick How-to tips and tools for spreading the practice of teach-back to nursing staff. Ruth Zimmerman Summit Health, AZ Jackie Conrad, RN, MBA, RCC Betsy Lee, RN, MSPH Improvement Advisors, Cynosure 1:55-2:00 p.m. Bring it Home 6 Erin Craig, MPA Senior Program Manager, HRET
Who is in the Room? What department do you represent? o Nursing o Rehab o Pharmacy o Medical Staff o Quality o Administration o Other 7
Teach Back Uptake How far along is your organization in utilizing teach back to solidify patient and family engagement? o o o o o Not thinking about it Thinking about it Started planning Have implemented on a small scale Have implemented fully and maintaining 8
Heads Up! Start thinking what will be your next move? What are some practical applications of today s presentation that you can implement in your acute setting to reduce falls among your patients? Be ready to chat in your response after the hospital story 9
Fall Data Resources and Update Mariana Lesher, MS Data Director HRET 10
Data Resources Falls Fact Sheet EOM Encyclopedia of Measures 11
Falls Data Update October through March hovering above the HIIN baseline. Data submission is below 70% of expected for the entire period. For hospitals with baseline and some 4Q 2016 data (n=1,057) 55% meeting program goals or maintaining a zero rate 12
Redesigning Patient Education: Patient Engagement and Autonomy Pat Quigley, PhD, MPH, ARNP, CRRN, FAAN, FAANP Nurse Consultant Retired Associate Director, VISN 8 Patient Safety Center Retired Associate Chief for Nursing Service/Research E-Mail: pquigley1@tampabay.rr.com 13
Objectives Consider patient / resident autonomy as primary factor Redesign patient/resident education to fully engage them as full partners in care Apply adult principles to two essential patient education strategies (Teach Back, Ask Me 3) Expand patient education resources
Questions to ponder... How do you know your patient education program is effective? Can you confirm that patients learned what you taught them? How to implement patient education for those with cognitive impairment?
Empowering Patients and Families Through Learning
My Focus: Patient Falls
Partnership Patients Need support and education to make good choices Benefit from easy to use directives Need to be accountable Need practical examples to put principles into place Family Partners in Care Advocates, Information Gatherers Messengers Provide ongoing assessment in the home Teach clinicians about their safe practices 18
Changing Your Conversation with Patients Do you label Patients / Caregivers: Non- Compliant? What does Non-Compliant Mean to You? How do you measure your effectiveness? How do you evaluate effectiveness of your teaching?
Autonomy What does this mean to you? What happens after a fall?
Patient Education is Not One Way Communication Think Systems Theory Teaching Individualized Fall Risk Factors A Simple Example: Blood Thinners What to do if you fall? Blood Thinners: Risk Factors and What to do when you fall
Program Effectiveness AND Implementation Effectiveness Program Effectiveness Implementation Effectiveness Outcome + program, - implementation = inconsistent, unsustainable, or poor outcomes - program, + implementation = poor outcomes
Teach Back Teach Back Testing: what are the trends in patients difficulty to understand what is taught? Ask the patient to describe or repeat back in his or her own words what has just been told or taught. Return demonstration is a similar technique used by diabetic educators, physical therapists, and others. When the health professional hears the patient s description in her/his own words, further teaching can be accomplished to correct misunderstandings. Never ask whether patients understand; they always say yes.
Teach Back Language I want to be sure I explained everything clearly. Can you please explain it back to me so I can be sure I did? I want to make sure I explained this clearly. When you get back home in a few days, what will you tell your [friend or family member] about [key point just discussed]? Teach Back Question Card #1 Teach Back Question Card #2 We covered a lot today about preventing falls, and I want to make sure that I explained things clearly. So let s review what we discussed. What are three strategies that will help you prevent falls? I want to be sure that I did a good job of teaching you today about risk for falls. Could you please tell me in your own words what you are doing to prevent falls? How you will prevent falls in the future? Teach Back Question Card #3 Teach Back Question Card #4
When Teach Back Is Especially Important: New medications A new diagnosis Instructions for calling for help to BR Instructions for self care e.g. ask, How can you stay safe from falling in the hospital? Patients are cautioned on how to prevent falls in the hospital e.g. young male patients who suddenly have high doses of pain meds but want to toilet themselves. Ask, How will you best prevent yourself from falling when you are given this powerful drug for pain that is known to cause falls?
Ask Me 3 1. What is my main problem? 2. What do I need to do? 3. Why is it important for me to do this? http://www.npsf.org/askme3/
Ask Me 3 Adapted for Falls How many patients understand what we teach them? Teach patients with this format: 1. Their main problem putting them at fall risk 2. What they need to do to keep from falling in hospital 3. Why is it important for them to do this Check the family s understanding: 1. What is the patient s main problem? 2. What can the patient to do to stay safe from falling in the hospital? 3. Why it is important for the patient to do this?
Teach Back in Action 7 key points
Teach Back in Action 7 key points
Knowledge Test
Return Demonstration 31
Teaching: After a Fall Reframe patient education curricula to include "what happens after a fall". What can we learn from this event? How can we work together to prevent this again?
Evaluating Your Teaching A one time test of knowledge - is that enough? Do you teach a diabetic patient how to manage diabetes one time? Isn t fall risk management complex? Why did we start using non-compliance? I can teach a Stroke Patient how to safely transfer Why? But how you teach a right brain CVA is different than a left brain CV
Patient Educational Materials CDC STEADI Staying Independent: Are you at risk? (English) What you can do to prevent falls (English, Spanish, Chinese) Chair Risk Exercise (English, Spanish) Postural Hypotension (English, Spanish) Check for Safety Brochure (English, Spanish) VA National Falls Toolkit / VISN 8 PSCI (Patient Safety Center of Inquiry) Hip Protectors (video and brochure; pts and caregivers) Osteoporosis and Men (video) Blood Thinners: What to do if you fall What to do when you fall Wall of Education Materials Group Classes How to fall and how to get up
Patient Educational Materials Fall Prevention Tips for Hospital Patients and Families
Toolkits and Best Practice Recommendations for Fall Prevention AHRQ Falls Prevention Toolkit VA NCPS Falls Toolkit ICSI Prevention of Falls Protocol IHI Reducing Patient Injuries from Falls How-to Guide Ganz DA, et al. Agency for Healthcare Research and Quality. 2013. VA National Center for Patient Safety (NCPS). 2014. Degelau J, et al. Institute for Clinical Systems Improvement (ICSI). 2012. Boushon B, et al. Institute for Healthcare Improvement. 2008.
To Change Practice is Not for the Faint of Heart! But.. You can change your teaching!
Evaluation of Learning Design patient education program evaluation as a knowledge and skills checklist for cognitive and psychomotor domains of learning. Include Health Literacy Assessment to check ability to comprehend and use health information
Pat And Her Mom Getting ready to dance
Implementing Teach Back at Summit Healthcare Ruth A. Zimmerman RN, MSN, CPPS Patient Safety Manager Nanette Garvin, RN, BSN Professional Development Specialist 40
About Us We are a not-for-profit rural healthcare organization serving the White Mountains of northeastern Arizona since 1970. Our 89-bed hospital includes a 32-bed Emergency Department, Level II Nursery, 12-bed ICU, medical/surgical and telemetry units, cardiac catheterization lab, Perioperative Services including a 4-suite OR, hybrid room, and special procedures rooms. We also have a strong presence in the community via outpatient clinics, physician offices, and various outreach programs. 41
Larry s Story 42
Why Teach Back? Recognized by AHRQ in 2001 and others as an evidence-based patient teaching strategy and top safety practice Requires active participation by the patient/family, which is known to increase learning and retention of material taught A mechanism by which patient/family readiness for discharge and ability for self-care can be assessed The right thing to do May play a role in decreasing readmissions Varying degrees of overall literacy and profound shortcomings in health literacy often related to education, language preference, age, ethnicity, low socioeconomic status Patients at highest risk often have multiple comorbidities which compound their lack of understanding 43
Our Teach Back Tale We have been very slow to adopt Requires understanding that yes/no questions will not validate patient understanding Focus on Nursing, but certainly opportunities in other disciplines Some staff already using this method but unaware they were doing so Teach Back used as a tool to teach Teach Back in nursing orientation and mandatory skills fairs 44
Respecting Patient Autonomy in ED Shifting focus to respect patients right to refuse aspects of fall prevention program, while still providing staff with useful tools Willingness to accept that some patients will make bad choices Meeting in the middle Installing curtains in ED bathrooms Placing bedside commodes in as many rooms as possible Providing signage outside of rooms to communicate various risks 45
Educating the Inpatient Robust inpatient fall prevention program Many possible interventions All employees taught about program Patients assessed at regular intervals Fall rates well below benchmarks Patient/family education a relative weakness No real tools to assist staff Lack of standardized language 46
The Falls Agreement Developed and implemented by the Fall Team Reminds patients that even simple acts become more difficult in the hospital setting Asks patients to partner with us in keeping them safe Patient/family signature Posted in the patient room 47
Implementation Hurdles Lack of staff familiarity with Teach Back and its importance to patient understanding Staff reluctance to use scripted language Original fall agreement written at high reading level (12+) and not well used by staff Revised agreement at more appropriate reading level but still not used extensively Agreement now included in patient admission packet 48
Learn from Our Mistakes Engage staff more fully in the development process Solicit buy-in from unit leadership: directors, charge nurses, champions Tell the story of why Continue to educate and monitor until fully implemented Provide practice sessions, perform unit rounding and audits, solicit input 49
Where to Next? We still have work to do in making sure Teach Back is being used across the organization Educate staff on the use of the fall agreement Consider a fall agreement for ED patients Questions? Please contact us! Ruth Zimmerman: 928-537-6708 or rzimmerman@summithealthcare.net Nanette Garvin: 928-537-6571 or ngarvin@summithealthcare.net Thank you for your time! 50
Take a Moment.. 51
Please Chat in the Box What are some practical applications of today s presentation that you can implement in your acute setting to reduce falls among your patients? 52
Tips to make teach back stick Questions for the presenters and participants: How did you overcome staff reluctance to use a script? How did you support staff assessing cognition and using teach back on appropriate patients? How is the use of teach back monitored? Where is the result of teach back documented in the health record? 53
Polling What component of the presentation did you find most applicable to assist you with improving your patient education program for falls? o o o o o Patient education and materials Front line staff engagement, and program development and implementation Best practices: Teach Back, Ask Me 3 Evaluating health literacy in existing education materials All of the components of the presentation are applicable to my acute setting and will help me improve my patient education program for falls 54
Bring it Home 55
Resources Teach Back and Health Literacy Resources AHRQ Literacy Universal Precautions Toolkit Ask me 3 Always Use Teach-back! Website includes competency checklist, training tools Dr. Patricia Quigley s Article Article: Autonomy and the patient's right to choose falls prevention Sample Patient Agreements Prevent a Fall: Patient Agreement CoxHealth Patient Agreement Patient Education Tool Fall Prevention Tips for Hospital Patients and Families 56
Falls Resources Hospital-Wide LISTSERV Join the LISTSERV Ask questions Share best practices, tools and resources Learn from subject matter experts Receive follow up from this event and notice of future events 57
Thank You! Find more information on our website: www.hret-hiin.org Questions or Comments: HIIN@aha.org 58