Is There Enough Time for Patient Teaching and Teach-Back in Fast Paced Acute Care Settings

[brcanda3]

I've been nursing for 20 yours in an acute care setting and love my profession and always looking for ways to improve. Please see how you can help me below:

I work on a Medical Telemetry Unit where the nurse to patient ratio is 4 to 1 and at times 5 to 1. Our length of stay averages 2.8 day and there are 36 beds. With the business of the unit I find nurses are unable to reach out to teaching so that it is effective. On an average day it looks like nurses are focusing on completing all their tasks, Meaningful Use and Public Reported documentation... which leaves minimal time for teaching. With the Federal Government wanting hospitals to decrease readmission by 20% it seems more time is needed with our patients and families for teaching. An example is a new heart failure patient. During your first morning round you assess the patient knowledge and management of heart failure. The patient knows nothing but to decrease his salt intake. You provide teaching sheets and DVD to view. You also pull up information about new medication like Coreg, Lasix, Potassium... The next nurse comes in and teaches information about the side effects of Coreg only. The next nurse comes on shift and talks about reading nutritional labels to determine the amount of sodium per serving. All teachback by the patient was done properly with each nurse. On the 3rd day this patient is discharged. Did any have time to share with this patient to weigh daily, write it down, and when to notify MD of weight gain? NO!. This patient is given a follow up visit to PCP within 3 days but doesn't go and is readmitted with SHOB after 9 days. After review of readmission it was identified that this patient didn't have a scale at home and didn't know he was to weigh daily. The process starts all over again because the nurses still don't have the time to reach out to teaching.

What are your thoughts about the time staff nurses have to devote to quality education to our patients? Share what you are doing differently in your organization to allow more time with patients and families for teaching and teachback?

[Cordee2010]

Hello, I retired from the VA last summer. During my last 6 years I worked as Outpatient Case Manager and Inpatient Case Manager using Internal criteria to manage my load. Chronic diseases such as CHF and Diabetes are a big deal in the hospital. At the VA we identify those patients on day#1 and refer them to the CHF clinic or Diabetic educator. They have a more comprehensive teaching tool that is also provided to the patient in writing. It is very important the communication with the PCP and the education that the patient is receiving as outpatient. As an outpatient CM I had "Nurse Appointments" to see CHF, Diabetic and Hypertension patients. Weight, medication adherence, barriers of treatment and nutrition education assessed. I believe that what you describe is more of a System (institution problem than an individual problem. As per Interqual Criteria a CHF patient have 3 days as inpatient, but if education is not completed Home health Care can be order for Medication and disease process education. A nurse will go to the home and reinforce and/or complete what was initiated at the hospital. HHC services scan start day 2 after discharge with the goal of reducing readmission.