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Journal of Nursing

Utilizing the “Teach Back” Method Approach in Reducing Medical Errors in Patients After Discharge.

Lise Anne Ross [email protected]

Background



Individuals used to remain in the hospital until well enough to go home, however the
length of hospital stays has shortened, and less time is made available to the patients for the
learning of new medications and homecare skills (Kornburger et al., 2012). Due to this loss of
time spent in the hospital, it becomes even more vital for the patient to understand the discharge
teaching being given. The teach-back method is an educational strategy that can be utilized by
nurses and health care professionals to explore how well information was taught to the patient, it
is not a test of the patients’ knowledge (Dihn, Clark, Bonner, Ramsbotham, & Hines, 2016). The
teach-back method approach, allows for nurses to verify patient understanding by asking the
patient to repeat and demonstrate the discharge teaching provided by the nurse (Kornburger et
al., 2012). Utilizing this method has been shown to decrease medical errors after the patient has
been discharged and decrease the likelihood of readmission (Kornburger et al., 2012). It is
essential for all nursing staff to be able to assess, teach, and determine that a patient
comprehends the discharge teaching being provided, using teach back allows the nurse to
evaluate that the patient is ready for discharge (Kornburger et al., 2012). The discharge process
can be confusing and hectic, and research has shown that when patients and caregivers do not
fully understand instructions provided it leads to decreased medication compliance, medication
errors, and hospital readmission (Kornburger et al., 2012). Utilizing the teach-back method has
been reported to clarify any questions the patient may have, while also helping to ensure a safe
transition from hospital to home (Peter et al., 2015). This article will discuss the rationale for the
teach-back method approach to discharge instruction, explain how to utilize this type of
discharge teaching, why it is beneficial, and to discuss any barriers

Steps to Using the Teach-Back Method



Teach-back is an evidence-based tool that can be utilized by health care professionals to
help evaluate a patients understanding of new medications and discharge instructions, it is a nonshaming
approach that asks the patient to repeat in their own words what they need to know or
do post discharge regarding their care (Tamura-Lis, 2013). Approximately 40-80% of health
information that is given to a patient is forgotten immediately, and nearly half of it is retained
incorrectly, thus making the teach-back process vital before discharge (Farris, 2015). When
beginning utilization of this process it is important to remember to speak slowly, speak clearly,
break down the information into short statements, and use illustrations if available (Tamura-Lis,
2013). Keeping that in mind, the process begins by evaluating the patients’ health literacy level.
Health literacy is defined as a person’s ability to comprehend, obtain, and process health
information, it is a way to see how much the patient already knows regarding their health and
medical regimen (Kornburger et al., 2012). Approximately 47% of the United States population
have trouble understanding information provided by health care professionals (Kornburger et al.,
2012). This is why determining the patients’ health literacy level is the first step, this helps to
ensure that the information provided is at a level that the patient can understand and what the
patient already knows. The next step is to teach the patient or caregiver the skill, this is either
verbalized or demonstrated by the nurse. After explaining or demonstrating the skill, the nurse
needs to clarify that the information given was understood, this can be done by asking “I want to
make sure I explained this correctly, could you please tell me how you will give this medication
at home?” After this the patient or caregiver will verbalize or demonstrate the information that
was provided by the nurse. At this point, the nurse will be able to assess whether the information
was understood or not, and if it was completed correctly then teach-back is complete. If the
information was not demonstrated or verbalized correctly, the nurse should clarify and
demonstrate the skill again, and then have the patient repeat or demonstrate the information
afterward. Lastly, after the teach-back process is complete the nurse should ask the patient or
caregiver if there are any questions. This provides an additional opportunity for the nurse to
assess that teaching was given correctly. The visual below shows a step-by-step process on
statements and questions that can be utilized while using the teach-back method.

These statements and questions help to provide a non-judgmental and shame-free setting, which
helps to ensure that the patient or caregiver are comfortable with the discharge instructions.

Benefits



The greatest benefit to the teach-back method approach is that it can be used with patients
of all health literacy levels, and there is no one patient that is recommend for this type of
discharge teaching. The benefits to this approach of discharge teaching have been indicated to
improve patient understanding, increase medication compliance, decrease callbacks and
cancelled appointments, and overall improve patient satisfaction and outcomes (AHRQ, 2015).
Furthermore, studies that have targeted utilization of the teach-back method have been shown to
improve patient comprehension, informed consent, and reduce readmission rates (Dihn, Clark,
Bonner, Ramsbotham, & Hines, 2016).

Barriers and Limitations



One of the biggest barriers to the teach-back method is that despite utilization of it,
patients or caregivers can still feel reluctant or embarrassed to ask questions regarding what was
taught to them out of fear of bothering or annoying the nurse when the nurse may have other task
to complete (Kornburger et al., 2012). This is why it is so important to create a nonjudgmental
environment with the patient when discharge instructions are being provided. Some of the other
barriers are that it is utilized incorrectly, time constraints amongst health care professionals, and
there is no standardization of discharge teaching despite it being a Joint Commission requirement
(Slater, Huang, & Dalawari, 2017). All of these barriers contribute to the need for a more fluent
discharge teaching plan for patients.

Discussion



The purpose of this article was to explore the rationale for the teach-back method
approach to discharge instruction, explain how to utilize this type of discharge teaching, why it is
beneficial, and to discuss any barriers. Because up to 80% of patients are not compliant with the
prescribed medical treatment regimen after discharge, this suggest that proper discharge teaching
was never provided (Bowskill, & Garner, 2012). Based on these findings it is necessary to find a
method that allows for proper discharge instructions. The teach-back method approach is an
effective way to improve health education and literacy amongst patients and caregivers, and
should be adopted by more healthcare facilities. This method allows for the nurse to verify that
health information that is taught to the patient or caregiver is done correctly, thus reducing
medication errors, hospital readmissions, and helping to ensure a safer transition from the
hospital to the home.

References



Agency for Healthcare Research and Quality (2015). Use the teach-back method: Tool #5.
Health Literacy Universal Precautions Toolkit. Retrieved from:
https://www.ahrq.gov/professionals/quality-patient-safety/qualityresources/tools/literacy-toolkit/healthlittoolkit2-tool5.html
Bowskill, D., Garner, L. (2013). Medicines non-adherence: adult literacy and implications for
practice. British Journal of Nursing, 21(19).
Dihn, T.T.H., Bonner, A., Clark, R., Ramsbotham, J., Hines, S. (2016). The effectiveness of the
teach-back method on adherence and self-management in health education for people
with chronic disease: A systematic review. JBI Database of Systematic Reviews &
Implementation Reports, 14(1), 210-247.
Farris, C. (2015). The teach back method. Home Healthcare Now, 33(6), 344-345.
Kornburger, C., Gibson, C., Sadowski, S., Maletta, K., Klingbeil, C. (2013). Using “teach-back”
to promote a safe transition from hospital to home: An evidenced based approach to
improving the discharge process. Journal of Pediatric Nursing, 28(3), 282-291.
Peter, D., Robinson, P., Jordan, M., Lawrence, S., Casey, K., Salas-Lopez, D. (2015). Reducing
readmissions using teach-back: Enhancing patient and family education. The Journal of
Nursing Administration, 45(1), 35-42.
Slater, B.A., Huang, Y., Dalawari, P. (2017). The impact of teach-back method on retention of
key domains of emergency department discharge instructions. The Journal of Emergency
Medicine, 53(5), e59-e65.
Tamura-Lis, W. (2013). Teach-back for quality education and patient safety. Urologie Nursing,
33(6), 267-271, 298. doi:10.7257/1053-816X.2013.33.6.267

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