Building Health Literacy- The How To s The Beryl Institute Patient Experience Conference March 2017 Rose Ann Simmons, Vidant Health Administrator Patient & Family Engagement Kathy Dutton, Vidant Medical Center Senior Administrator Patient & Family Experience Our mission Our vision To enhance the quality of life for the people and communities we serve, touch and support VISION Where incredible people provide incredible care every day Our values VALUES To improve the health and well-being of eastern North Carolina To become the national model for rural health and wellness by creating a premier, trusted health care delivery and education system Integrity Compassion Education Excellence our standard Compassion Accountability our distinction Teamwork our advantage Education Safety our investment Innovation our future Teamwork 2 Vidant Health Service Area 3 1
Our System of Care 12,000+ employees 8 hospitals 70+ physician practices Outpatient, home health and hospice services Critical care transport Serving 1.4 million people in 29 counties, 1/3 of NC 4 Objectives List the activities patient and family advisors were involved in throughout the process to build health literacy Describe the Always Events of Always Use Teach Back and S.M.A.R.T. Transition and how these are incorporated in daily workflows Describe how health literacy is a key patient engagement strategy 5 Activity Time 2
Patient and Family Advisors Involvement 2008-2011 2012-2014 Stamp of approval created for education and information content Patient Engagement Strategy work groups form: Patient Experience, Patient Education, Staff Education Patient Engagement Model Leadership role for patient engagement & health literacy Patient Activation Measure Partner with Information Systems for proposal of an enterprise solution for patient education content Standard Operating Procedure for creating Patient Education Checklist for creating easy to read material New After Hospital Care Plan (discharge instructions) Building Health Literacy module & Always Events 2015-2017 Patient Education Steering Committee Communication training & rounding with providers 7 8 Enhance Education and Build Health Literacy Standardize education for patients and communities across all settings of care Standardize patient education processes to include implementation of: Always Event of Teach Back Always Event S.M.A.R.T. Transitions S.M.A.R.T. = Signs & Symptoms, Medications, Appointments, Results, Tell Us Now & Teach Back 9 3
Standardizing Patient Education Where We Started Multiple vendors utilized for patient education material across the system, resulting in inconsistent material and format MicroMedex Custom Content Google 11 No Formal Approval or Review Process 12 4
Patient Education Definition Planned and self-directed learning experiences designed to help individuals and communities improve their health by increasing knowledge, skills, confidence and self-efficacy through shared decision making, teach back, motivational interviewing and shared care plans across settings 13 Patient Education Purpose Provide oversight of patient education resources and processes Responsible for review, prioritization and timeline proposal for Patient Education requests 14 Standard Operating Procedure 15 5
Implementing Always Events The Teach Back Method Health Care Team provides information and asks an open ended question - Patient or Care Giver successfully teaches the information - Health Care Team confirms understanding - Patient or Care Giver teaches the information back - Health Care Team listens and assesses understanding - Patient or Care Giver teaches the information back - Health Care Team listens and assesses understanding Health Care Team tailors the message and clarifies the information 17 S.M.A.R.T. Transitions A simple framework applied with each encounter to ensure 5 key topics are always addressed S = Signs and Symptoms M = Medications A = Appointments R = Results T = Tell Us Now & Teach Back 18 6
Your primary diagnosis was: Ischemic Heart Disease Your diagnoses also included: Tobacco Use, Type 2 Diabetes Mellitus, Controlled, High Blood Pressure Associated With Diabetes, High Blood Pressure, Arthritis, Chest Pain Due To Insufficient acetaminophen Blood 325 Supply mg Tab To Heart Commonly known as: TYLENOL Allergen Latex clopidogrel 75 mg Tab Commonly known as: PLAVIX metoprolol tartrate 25 mg Tab Commonly known as: LOPRESSOR Take 0.5 tablets by mouth twice Vitals a day. Temperature Notes to Patient: Take this medicine 37 C by (98.6 mouth F) with at 03/30/2016 1233 Heart a drink Rate of water. 64 at 03/30/2016 1233 Respirations 18 at 03/30/2016 1233 simvastatin 10 mg Tab Blood Commonly Pressure known as: zocor 120/72 mmhg at 03/30/2016 1233 Call Doctor's Office If Change In Mental Status Confusion, Restlessness, Anxiety Call Doctor's Office If Chest Pain Call Doctor's Office If Severe Pain That cannot be relieved by pain medication Call Doctor's Office If Shortness Of Breath Call Doctor's Office If Uncontrolled Nausea And Vomiting Reactions Hives Shortness of Breath Itching Call Doctor's Office if Constipation Trouble moving bowels or No bowel movement in 48 hours and not relieved by medication Call Doctor's Office if Temperature Is (Please Specify) Call for temperature greater than 101F In The Case Of An Emergency, Call 911 If you are unable to reach your Doctor or Go to the nearest Hospital. 1 ThismaterialcontainsconfidentialandcopyrightedinformationofEpicSystemsCorporation. 2 ThismaterialcontainsconfidentialandcopyrightedinformationofEpicSystemsCorporation. Tell Us Now An innovative approach for patients and families to actively share compliments, comments, or concerns A way to encourage open communication and promote high quality, safe care and exceptional experiences in care An opportunity to listen and learn for ways to improve experiences of care 19 S.M.A.R.T. Transition Tools: EHR Checklist 20 S.M.A.R.T. Transition Tools: After Hospital Care Plan 21 When More Information Your About Caring Hospital to Your For Call Yourself Stay Medications Doctor At Home Here Weight Daily Medications Your The the following Medication Follow-Up information management are instructions about List an important Appointments your will part current help of you your stay and care the your plan. hospital. caregivers Please Please review know take how this the to medication best care list for carefully your health Call information This because This needs your doctor your a at some with list home. final you immediately medication of follow-up of when Educational you if go you list. the medications appointments to information your Please have doctor any ask might with be about of or the the other nurse your different health following: health any doctor than topics care questions other what that provider health you may about used care be the to of your provider(s). take. help medications. 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The to following help you information deal with includes stress details in your about home your and work life. hospital Avoid metoprolol stay caffeine. along tartrate with steps 25 you mg should Tab take to help with your recovery after you leave the hospital. Information about the topics listed below, are included in this care plan. Managing Commonly Diet known as: LOPRESSOR Discharge A summary of References/Attachments your Medication hospital stay Take 0.5 tablets by mouth twice a day. ANGINA, Signs and DISCHARGE Symptoms to INSTRUCTIONS look for and who you FOR can (ENGLISH) call after you leave the hospital Last Your Medication time health this care was information given: provider and 12.5 will instructions mg give on 6/1/2016 you information 10:15 AM on dietary changes that you may need to make, based Take Keep 10 mg a by record mouth every of your evening. episodes of chest pain. Take these with you when you see your doctor. 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If you notice any of these CONTINUE signs or have taking any of these symptoms medications Taking this list call your doctor. clopidogrel Results Reducing for Nitroglycerin 75 tests fat and mg Tab completed cholesterol during intake your hospital stay are available for your review in Date Commonly MyChart. of Reducing Admission: known Please sodium 5/25/2016 as: share (salt) PLAVIX your intake, results especially of these if you tests have at high your blood follow-up pressure appointments. Take Keep Increasing 75 mg your by nitroglycerin mouth your intake daily. with of fresh you vegetables at all times. and fruits Date Last Additional of time Discharge: this was Information 6/1/2016 If you re Eating on lean nitroglycerin, proteins, given: 75 such mg don t as 6/1/2016 take fish, poultry, medications 10:15 and AM legumes used to treat (beans impotence and peas) at and all. 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Vidant Medical Center 1 STOP South Physical o Sit down (you taking these MyChart activity may become dizzy). medications Activation Code: 6DNBC-VR9KR 2100 o IMITREX Stantonsburg Place 1 tablet 100 mg Road under Expires: Tab Po Box your 10/25/2016 6028 tongue, or between your lip and gum, or between your cheek and gum. 4:20 PM Greenville Generic Your Let health drug: NC the 27835 care tablet sumatriptan provider dissolve may completely; recommend do that not chew you increase or swallow your the physical tablet. activity if you have not been as 252-847-4100 active Follow o If as you the possible. use on-screen a spray, Depending instructions then spray your to once set situation, up your or under your account. provider your If tongue. you may have recommend Do questions, not inhale. that email Close you include your mouth. moderate Wait oxycodone to mychart@vidanthealth.com. vigorous a few seconds intensity CR 10 mg physical before Tb12 you activity swallow for at and least don't 40 rinse minutes your each mouth day for 5 at to least 10 minutes. 3 to 4 days per week. A Commonly few o examples After known taking of as: moderate 1 tablet oxycontin or to spraying vigorous CR once, intensity continue physical sitting activity for 5 include: minutes. o If the angina goes away completely, rest awhile and follow your doctor's orders about returning to Walking your normal at a brisk routine. pace, about 3 to 4 miles per hour Where Jogging to Get or running Your Medications o You have If the received chest pain a or paper pressure prescription continues, for CALL all of 911 the immediately. below medicines. Do NOT Do delay. not leave You may without be having Swimming or water aerobics this paper a heart prescription attack (acute and myocardial take it to infarction, the pharmacy or AMI) of your choice. o Hiking You may be told by your doctor to CALL 911 after taking 2 or 3 tables or sprays of nitroglycerin - metoprolol Dancing (spaced 5 minutes tartrate 25 apart) mg Tab and the chest pain or pressure is still present 5 minutes after the last dose. Martial Do not arts take more than 3 tablets, or spray more than 3 times, within 15 minutes. Tennis Riding a bicycle or stationary bike Dancing 9 ThismaterialcontainsconfidentialandcopyrightedinformationofEpicSystemsCorporation. 7 ThismaterialcontainsconfidentialandcopyrightedinformationofEpicSystemsCorporation. 6 ThismaterialcontainsconfidentialandcopyrightedinformationofEpicSystemsCorporation. 4 8 ThismaterialcontainsconfidentialandcopyrightedinformationofEpicSystemsCorporation. 5 ThismaterialcontainsconfidentialandcopyrightedinformationofEpicSystemsCorporation. 3 ThismaterialcontainsconfidentialandcopyrightedinformationofEpicSystemsCorporation. 7
S.M.A.R.T. Transition Tools: Handbook Checklist 22 Clinical Application Compassionate Collaborative Care Compassionate, collaborative care (Triple C) framework promoting humanistic attributes and behaviors Residents and supervising faculty go through didactic sessions on patient communication involving active learning tools Patient Advisor and Patient Experience Leader participate in interprofessional bedside rounds with direct observation and feedback Staff Nurse engaged in attending rounds ensuring communication board plan of care updated 24 8
Compassionate Collaborative Care: Key Attributes and Behaviors Focus your attention Recognize nonverbal cues Actively listen Show interest in the whole person Respond to emotions, concerns, distress Share information and decisionmaking Demonstrate trustworthiness Communicate with colleagues Practice selfreflection Foster personal wellbeing and resilience 25 Beginning Courtesy & Respect Focus your attention before entering the room Knock, introduce yourself and describe your role Make a connection with patient and family 26 Middle Explaining Things Explain the elements of the plan of care Seek the input of the inter-professional team Ask and acknowledge the patient and family s input Listen actively Convey empathy and compassion Use Words that Work 27 9
End Listen Carefully Update communication board Confirm understanding with open ended questions and Teach Back Observe and address the patient s emotions, reactions, non-verbal cues Use Tell Us Now Express appreciation 28 Activity Time Next Steps- Informed to Engaged Culture Transformation Patient Activation Measure Primary Care Redesign Patient Engagement Technology 30 10
31 Questions? Rose Ann Simmons rsimmons@vidanthealth.com Kathy Dutton kdutton@vidanthealth.com 32 11