Implementing teach-back using improvement methodology 11 th March 2013 Julie 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 Home self- management G.P. primary care Respiratory Clinic specialist care Hospital paediatric ward Childs Care Pathway Baseline data Sample from Respiratory Clinic Attendees (Jan-March 2011) - healthcare professional who delivered initial inhaler technique training One Puff Ten Breaths 30 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 Outcome Aim: Increase asthma medication self management for children admitted to Wishaw General Hospital paediatric ward, with asthma or viral wheeze by July 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 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 & training Methods 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 childs 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 1Sample 2Sample 3Sample 4Sample 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 wouldnt want to try) 2 Disagree (not really confident prepared to try) 3 Undecided (not sure havent had opportunity to try it) 4 Agree (confident about technique have/havent 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) NHS Lanarkshire / IA Asthma Inhaler Project Implementation 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 1Yes 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 childs 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 technique Clinic: _________________________ Asthma Inhaler Project Data Collection: Outpatient Clinic assess new referrals knowledge of multi-dose technique Clinic: _________________________ 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 motivateinfuse teachermentor imaginationteamwork success Any Questions?