Implementing teach-back using improvement methodology

11th March 2013Julie Adams

Senior Programme Manager, NSD

Wave 18

The Project!

My project

Evolution of the aim:

Children not taking the prescribed dosage (compliance) for their

inhalers – preventable hospital admissions

Inhaler technique

Discrepancies between hospital and community

pharmacy systems

Health literacy issues

Preventative Care / Acute Management

Medicines reconciliation

Specialist Clinic

Re-admissions

Child’s Care Pathway

Baseline data

Baseline data

Sample from Respiratory Clinic Attendees (Jan-March 2011) - healthcare professional who delivered initial inhaler technique training

One PuffTen Breaths30 seconds

between ‘puffs’

Multi-dose technique in NHS Lanarkshire

What are we trying to

accomplish?

Improve self-management

processes linked to asthma

medication during an

acute inpatient

admission, by June 2011.

Outcome Aim:

Increase asthma medication self

management for children

admitted to Wishaw General

Hospital paediatric ward, with asthma or viral wheeze by

July 2011.

Evolution of the aim:

Children not taking the prescribed dosage (compliance) for their

inhalers – preventable hospital admissions

Inhaler Technique

Teach-Back Technique

Use own inhaler

medication

Staff Education

Children discharged - using correct

inhaler technique

Measure of Compliance

Medicines Reconciliation

Children discharged - using correct

inhaler dosage

Increase asthma

medication self

management for children admitted to

Wishaw General Hospital

paediatric ward, with asthma or

viral wheeze by July 2011.

Asthma medication – medicines management processes

Self-management

Discharge processes

Children bring their asthma medication into hospital within 24 hrs of admission

Asthma medication reconciled prior to discharge

Asthma discharge checklist compliance

Standardised discharge self-management education

Inhaler technique training highlighted at nurse handovers, safety briefings and multi-disciplinary ward rounds.

Children/parents involved in discharge medicines reconciliation

Ward staff delivering asthma self-management education

Inhaler technique training

Asthma medication reconciled within 24 hours of admission

95% of all children will receive asthma inhaler

technique training prior to discharge.

% of children with own inhaler on

ward

% of staff trained to deliver asthma inhaler

technique training

% of self-management education delivered by

ward staff ward

% of inhaler medication

reconciled on admission

Measures

Self-management of asthma medication

Developing teach-back tools & trainingMethods to check understanding.......

Please show me how you use the asthma inhaler?

When you feel wheezy - what will you tell your mum, dad or teacher

should happen?

‘We discussed a lot today. Can you tell me what you found most important about your

child’s condition?’

Measures……

Measure – operational definition:Choose random day of the week and ask first 5 members of staff on Wd 20, from middle of May (post-training - every 2 weeks) about inhaler technique / teach-back mechanism – using same questions. To assess what percentage describe the correct multi-dose technique/confidence in using teach-back.

Sample 1 Sample 2 Sample 3 Sample 4 Sample 5 Weekly Total

Week Beginning

Can you describe multi-dose inhaler technique?1 puff/10 breaths/30 seconds between puffs.(enter 1-Yes or 0-No)

Have you had the teach-back training?(enter 1-Yes or 0-No)

Can you describe the teach-back?(enter 1-Yes or 0-No)

Are you confident in using teach-back?1 – Strongly Disagree (really not confident – wouldn’t want to try)2 – Disagree (not really confident – prepared to try)3 – Undecided (not sure – haven’t had opportunity to try it)4 – Agree (confident about technique – have/haven’t used it)5 – Strongly Agree (very confident – can give example of using technique)

Have you used teach-back with parents? (enter 1-Yes or 0-No)

Cycle 8 – test change to training delivery to emphasis the teach-back element of the training.

Cycle 7 – repeat Cycle 6 test – to gain a bigger sample to assess if changes are needed to the delivery of the training.

Cycle 6 – Assess the data collection tool to measure the effectiveness of the training, i.e. ask staff to describe teach-back and ask how confident they are in using this method?

Cycle 5 – test data collection methodology to assess effectiveness of teach-back & multi-dose technique training, i.e. randomly asking 5 members of staff each week.

Cycle 4 – test data collection method to monitor progress of teach-back & multi-dose technique training, i.e. central training records and weekly charting.

Cycle 3 – test teach-back training pack with facilitators

Cycle 2 – test draft teach-back training package.

Cycle 1 – Adaptation of NHS Lothian teach-back training package & assess if suitable use within the paediatric ward in Wishaw to support the Asthma Inhaler Project.

NHS Lanarkshire / IA – Asthma Inhaler ProjectImplementation of Teach-back training

Measures……

Plateau of training

Outcomes – medicines reconciliation

Outcomes – inhaler technique

Results…..

Data collection issues – within 24 hrs / prior to

discharge

Measure – operational definition:Assess effectiveness of inhaler technique training delivered, during in-patient episode on Wd 20.All new referrals will be asked about:multi-dosing technique;teach-back. (Outcome measurement to assess effectiveness of multi-dosing technique & teach-back.)

Sample 1

Sample 2

Sample 3

Sample 4

Sample 5

Sample 6

Sample 7

Sample 8

Weekly Total

Week Beginning

Referral Pathway: (enter: GP or Paediatric Unit WGH)

Outcome Measure: percentage of new referrals – that required inhaler-technique training. (enter 1–Yes or 0-No)

Did anyone teach you how to use the inhaler?(enter: GP, WGH, No)

Ask parents – can you tell me how to use your child’s inhaler? How many described the correct multi-dose technique: 1 puff/10 breaths/30 seconds between puffs.(enter 1-Yes or 0-No)

If child has been in WGH – can the parents describe how the inhaler technique was taught to them – did they describe a teach-back method? (enter 1-Yes or 0-No)

Asthma Inhaler Project – Data Collection: Outpatient Clinic assess new referrals knowledge of multi-dose techniqueClinic: _________________________Asthma Inhaler Project – Data Collection: Outpatient Clinic assess new referrals knowledge of multi-dose techniqueClinic: _________________________Asthma Inhaler Project – Data Collection:

Outpatient Clinic assess new referrals knowledge of multi-dose technique

Clinic: _________________________

• Implementation of system of reviewing asthma multi-dose inhaler technique - using teach-back.

• The Respiratory Clinic:– increase in no. children demonstrating correct inhaler technique

(after hospital admission);– reduction in need for specialist education.

• Conclusion:– benefits of teach-back demonstrated.

• Next Stage:– monitor readmissions;– engage with primary care clinicians to support inhaler technique

education within primary care.

Achievements so far…..

Ingredients for successful project:IA skills:

Leader

motivate

infuse

teacher mentor

imagination teamwork

success

Any Questions?