Communication problems

Inadequate information flow

Human problems
Patient-related issues
Organizational transfer of knowledge
Staffing patterns/work flow
Technical failures
Inadequate policies and procedures
(AHRQ Publication No. 04-RG005, December
2003) Agency for Healthcare Research and
Quality
1. Communication
2. Patient Assessment
3. Procedural Compliance
4. Environmental Safety/Security
5. Leadership
Sources: Michael S. Woods, M.D., How Communication Complicates the Patient
Safety Movement, Patient Safety & Quality Healthcare, May/June 2006; Joint
Commission on Accreditation of Healthcare Organizations, 2006; H&HN
research, 2006

STIMULUS
ENCODER
STIMULUS
DECODER
UMPAN BALIK
The Joint Commission for Accreditation for
Health Organization has listed effective
communication as goal no.2 of the 2006
National Safety Goals.
Effective communication depends on clarity: the
speaker must convey his or her message in
such a way that the listener clearly understands
that message.
But the truth is communication is influenced by a
host of factors: gender, ethnicity, culture,
professional dynamics. So a speakers intended
message may not be what the listener hears or
understands, which can compromise patient
safety.
Effective communication must meet certain
standard when delivering information from the
sender to the receiver. Information that is being
communicated must be clear and easily
understood. Some buzzwords are confusing and
might lead to misunderstanding, so use it with
caution.
Effective communication must be complete. All
pertinent information must be said with less
unnecessary details. Too much use of the details
can also confuse the receiver instead of helping
one to understand.

Timeliness of giving the information is
important especially when communicating
with patient care related issues. Timeliness
also gives a true sense of urgency. Any
delays in patient-related communication
will often lead to patient being
compromised.
The information communicated must be
acknowledged and verified by the receiver
in order for the exchange of information to
be effective.

Improved communication is one of the Joint Commissions 2006
National Patient Safety Goals. JCAHO requires organizations to
establish processes that will help eliminate communication errors, such
as:
Have individuals verify verbal and telephone orders and critical test
results by reading back the complete order or test result.
Standardize a list of abbreviations, acronyms and symbols that are
not to be used throughout the organization.
Measure, assess and, if appropriate, take action to improve the
timeliness of reporting, and the timeliness of receipt by the
responsible licensed caregiver, of critical test results and values.
Implement a standardized approach to hand off communications,
including an opportunity to ask and respond to questions.

Source: Joint Commission on Accreditation of Healthcare Organizations, 2006; H&HN research, 2006
1. Culture/Ethnicity
A patients culture may influence how he or she interacts
with caregivers. Language barriers can cause
misunderstandings and miscommunications.
2. Socioeconomics
Levels of education, literacy, economics, beliefs and
behaviors can differ tremendously among patients, can
affect the ability of staff to communicate with one another
(e.g., nurses and doctors) and can lead to
miscommunication.
3. Literacy
How well does the patient understand medical terms? Can
the patient follow take-home instructions?
4. Gender
Gender influences relationships among staff and
between caregivers and patients.
5. Personality/Behavior
Individuals personalities color their daily
communication and influence how others perceive
them.

Urgency affects a speakers tone. For example, a
hurried doctor or a stressed-out nurse may be perceived
as curt by the patient or other staff.

Sources: Michael S. Woods, M.D., How Communication Complicates the Patient Safety Movement, Patient Safety &
Quality Healthcare, May/June 2006; H&HN research, 2006


Lack of structure, policies, and procedures
related to the content, timing, or purpose of
verbal reports.
No shared mental model or framework for verbal
healthcare communication.
No rules for verbal transmission of information,
either face-to-face or over the telephone.
Differing opinions, even among nurses, as to
what information should be communicated during
a verbal report.
Frequent interruptions and distractions.
Frequency of communication.
KOLABORASI

AREA KELABU PADAT RISIKO/ ERROR
( PELIMPAHAN SECARA TERTULIS / STANDING ORDER dan
SESUAI KOMPETENSI)
PRAKTIK
KEPERAWATAN
PRAKTIK
KEDOKTERAN
PERAWAT
DOKTER
15
For verbal or telephone orders
For reporting critical results
Method:
The individual receiving the information
Writes down the complete order or test result, or
Enters it into the computer
The individual receiving the information
Reads back what has been written
The individual who gave the order
Verifies the correctness
Check-back is a good way to verify
information especially when transcribing
a doctors order.
Medical orders must be reviewed for
completeness and clarity.
The medical orders must be questioned
if penmanship is illegible or
abbreviations are used that are not
acceptable by the institution.
Call-out is another technique when
a critical information is called out
during an emergency situation.
The critical information is said aloud
so that any team members present
during an emergency that are
hearing and listening to the
information.
Hand-off is another technique of verbally transferring
information, responsibility, and accountability of patient care
to another staff.
This includes the review of written report on the pertinent
patient information, the latest significant changes in patient
status, and the latest recommendation on the plan of care.
The receiving staff has to acknowledge the completeness,
pertinence of information, and accepts the responsibilities
in providing patient care.
Using the S-B-A-R method in hand-off will enhance
communication and promote a culture of patient safety.
S-B-A-R is an abbreviation for : Situation,
Background, Assessment and
Recommendation.
Giving information systematically and
consistently
SBAR should be used when giving patient
information between primary caregivers
regardless of discipline.
SBAR is a technique that
provides a framework.
easy-to-remember
allows for an easy and focused
way to set expectations

Communication Tools :
SBAR
Situation: What is going on with the patient?
What is happening at the present time?
Background: What are the circumstances
leading up to this situation?What is the clinical
background?
Assessment: What is the problem? What is
the current situation?
Recommendation: What should be done to
correct the problem?
------- Response/Repeat back: Repeat back the
plan of care


S : Situation
Kondisi terkini yg terjadi
pada pasien
B : Background
Informasi penting apa yg
berhubungan dg kondisi
pasien terkini
A : Assessment
hasil pengkajian kondisi
pasien terkini
R : Recommendation
apa yg perlu dilakukan
Untuk mengatasi masalah
Dapat digunakan
saat serah terima
perawat antar
shift, perawat ke
dokter saat
melaporkan
kondisi pasien,
dokter ke dokter.
S SITUATION
- nama. Umur, tgl masuk, hari
perawatan, dr yg merawat
- diagnosa medis dan masalah
kep yg belum dan sdh teratasi
B BACKGROUND
- keluhan uatama, intervensi yg
telah dilakukan, respon psn
diagnosa kep.
- riwayat alergi, rwyt pembedahan,
pemasangan alat invasif dan obat/
infuus
- pengetahuan pasien/ kel D/ medis

A ASSESSMENT

- jelaskan hasil pengkajian pasien
terkini tanda vital, pain score, tk
kesadaran, status restrain, risiko
jatuh, status nutrisi, eliminasi, hal
yg kritis, dll.
- hasil investigasi yg abnormal
- informasi klnik lain yg mendukung

R RECOMMENDATION
- rekomendasi intervensi keperawatan
yg perlu dilanjutkan ( refer ke nursing
care plan) termasuk discharge
planning
- edukasi pasien/ keluarga
example
S = Dr. Smith, this is Mary at General Hospital
calling regarding Mr. Cook in 212. His temperature is up to 103.5.
B = He is POD #2 S/P right knee replacement.
A = The wound is red; pulse is up to 115 from baseline of 80; his
pain level has increased to 9/10 despite increasing his Vicodin dosing
to ii tabs Q4.
Specific numerical values are given in the assessment
R = I would like you to come see him. When can I expect you?
Asking for a specific time frame


R = I will be there in 15 minutes, I am in the PACU.
MENINGKATKAN KOMUNIKASI PADA
SAAT OPERAN / HAND- Off
GUNAKAN BAHASA YANG JELAS
GUNAKAN TEHNIK KOMUNIKASI YG
EFEKTIF : kurangi interupsi, alokasikan
waktu yg cukup , terapkan read back atau
check back tehnik ,
Standarisasi laporan antar shift / antar unit
Saat transisi ==> pasien mau pulang/
pindah, berikan informasi yg jelas kpd
pasien/ kel: obat, diagnosa pulang,
hasil pemeriksaan, kapan dan dimana
konsultasi follow up
29
Standardized abbreviations, acronyms,
symbols, and dose designations
Do Not Use list
Do not use in medication orders
Do not use in medication-related
documentation
Do not use on pre-printed forms
Do not use in handoff communications to
other providers
Limit Abbreviations
The Joint Commission has a list of abbreviations that should not be used
on orders or on any medication-related documentation that is handwritten
or on preprinted forms. The list below provides the following substitutions:
JCAHO Do Not Use List








*Exception: Use a trailing zero where required to demonstrate the level of precision of the value being reported,
such as for laboratory results. It may not be used in medication orders or other medication-related
documentation.
Source: Joint Commission on Accreditation of Healthcare Organizations, 2006; H&HN research, 2006


Poor handwriting
Lotrison or Lotrimin ?
Coumadin or Kemadrin ?
Doxorubicin or Daunorubicin ? Pentobarbital or Phenobarbital ?