Patient safety and human factors: action on communication
Systems based approaches to improving communications look to build more open cultures, lessen the effects of stress and workload while flattening hierarchy and encouraging collaboration (Nadzam 2009). Characteristically these approaches use strategies that make breakdowns visible so that omissions or misunderstandings can be addressed before any harm comes to the patient.
A communication intervention should demonstrate the following characteristics. It should:
- be easy to understand and follow
- offer consistency and predictability
- feature "redundancy" - if the process fails in one part of the system another part offers the opportunity for the failure to be recovered
- incorporate forcing functions - users are steered to do the right thing in the right way
- reduce opportunity for "work arounds"
- reduce reliance on memory.
(Nadzam 2009).
Tools and interventions : SBAR
SBAR is a communication tool designed to support staff sharing clear, concise and focused information. SBAR stands for Situation-Background-Assessment-Recommendation.
Situation
- Identify yourself the site/unit you are calling from.
- Identify the patient by name and the reason for your report.
- Describe your concern.
Background
- Give the patient's reason for admission.
- Explain significant medical history.
- You then inform the consultant of the patient's background: admitting diagnosis, date of admission, prior procedures, current medications, allergies, pertinent laboratory results and other relevant diagnostic results.
Assessment
- Vital signs.
- Contraction pattern.
- Clinical impressions, concerns.
Recommendation
- Explain what you need - be specific about request and time frame.
- Make suggestions.
- Clarify expectations.
(NHS Institute for Innovation and Improvement n.d.).
The SBAR tool has been used in a range of different settings and been used by many different staff members, clinical and non-clinical. The SBAR prompts have been printed on notepads, pocket cards and stickers to remind staff to use the standard method of communication (Patient Safety First 2008).
The NHS Institute for Innovation and Improvement (NHS Institute 2006-2012) provides some downloadable resources about the use of SBAR including videos showing situations where SBAR is used to escalate the response to a situation. The University of Nottingham has devised a short piece of online learning about SBAR (University of Nottingham 2010).
References
These resources were last accessed on 25 March 2013. Some of them are in PDF format - see how to access PDF files.
Haig KM et al (2006) SBAR a shared mental model for improving communication between clinicians, Joint Commission Journal on Quality and Safety, 32(3) March, pp.167-175.
Nadzam DM (2009) Nurses' role in communication and patient safety, Journal of Nursing Care Quality, 24(3) Jul-Sep, pp.184-188.
NHS Institute for Innovation and Improvement (n.d.) SBAR presentation. Available at Safer care: SBAR resources, NHS Institute website.
NHS Institute for Innovation and Improvement (2006-2012) Safer care improving patient safety, Situation, Background, Assessment, Recommendation, NHS Institute website.
Patient Safety First (2008) The how to guide for reducing harm from deterioration (PDF 725.7KB), London: Patient Safety First.
University of Nottingham and NHS Institute for Innovation and Improvement (2010) Improving patient safety: SBAR, University of Nottingham website.
Go to: Human factors - communication.
See also information about other human factors and interventions.