Teach Back Training

Audit Form

Assessment of staff readiness to begin Teach Back with patients and family members

Required

Observed Date

Employee Number

Learner readiness

Did Learner complete assignment to view Teach Back video?

Did the Learner use positive statements during Teach Back?

Did Learner teach Observer and ask for Teach Back?

If Learner did not meet all requirements was additional education provided to the Learner by the Observer?