This tool leverages the teach-back method, which helps aid comprehension.
Over the course of a nursing career spanning more than three decades, Marjorie Abele has served in a wide range of roles. But it was her experience in an outpatient pulmonary program, teaching parents how to care for their babies with infant apnea, that changed the course of her career.
"It was an extraordinary opportunity to teach hands-on," says Abele, M.S.N., RN, now a health education specialist at Phoenix Children's Hospital's Emily Center. "That's when my love for teaching blossomed—I really felt the call to change roles."
Abele's career path in nursing has now connected her with patients and their families, educating them with the hospital's journey board program.
Teach-back is the key to success
A team of diabetes nurses at Phoenix Children's developed journey boards more than a decade ago to educate newly diagnosed patients and their families on their condition and on how to effectively care for themselves at home. Using an easy-to-read game board concept, the journey boards contain a series of squares with topics related to the child's care—each designed to spark conversations between families and providers.
Key to these conversations, and the journey board program itself, is the teach-back method. According to the Agency for Healthcare Research and Quality, patients immediately forget 40 percent to 80 percent of the medical information providers tell them during office visits, and nearly half of the information patients retain is incorrect.
Teach-back method is a way of checking understanding by asking patients to state in their own words what they need to know about their health. By using the teach-back method, the journey boards ensure patients, their families and their care teams are on the same page.
In addition to aiding comprehension of complex medical information, Abele says teach-back benefits the medical staff too. "It has revolutionized how I talk to people," Abele says. "The onus is on us to make sure we teach in a way that's meaningful to the family. Teach-back is just a way to make sure I did a good job as a nurse delivering the message."
Phoenix Children's integrated the education records reflecting journey board content into its electronic medical record (EMR) system to ensure compliance and proper documentation of family education. The clinical care team must sign off on required care topics in the journey boards prior to patient discharge.
The results thus far have been remarkable. For example, compliance for the diabetes journey board has increased steadily from 40 percent in early 2017 to nearly 100 percent marks every month since last fall.
The hospital recently surveyed 20 families following hospitalization for diabetes; 100 percent confirmed teach-back was used to validate their learning. Further, many reported the practice helped build confidence in their ability to manage their child's condition.
Expanding toward value-based care
The journey board program, which began in 2007 with a single paper-based board for diabetes patients, has grown to include 14 mobile app boards spanning a multitude of diagnoses, procedures and hospital units. Plans are in the works to release seven more journey boards, and EMR integration is rolling out across all apps. That data will be crucial for tracking readmission rates and facilitating reimbursements for Phoenix Children's, especially as medicine moves toward value-based models of care.
Still, Abele says the journey boards' original intent—medical education for patients and their families— remains at the program's forefront. "We just need to talk to people in a way they understand and make sure they understand with teach-back," Abele says. "The concept is simple."
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