Effective communication is an important aspect of patient care to ensure patient safety. The Joint Commission for Accreditation for Health Organization has listed effective communication as goal no.2 of the 2006 National Safety Goals.
Standards of Effective Communication
In most recent workshop that the writer attended, VHA, Inc.’s train-the-trainer team building program, effective communication is cited as one of the important skills for promoting team relationships. Based on this training program, the writer learned that there are several information transfer techniques that are used in health care to maintain a smooth flow of communication among the hospital staff. These information techniques are check-back, call-out, and hand-off.
Check-back is a good way to verify information especially when transcribing a doctor’s order. Medical orders written for a patient 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. When doctor’s orders are reviewed, it must be transcribed correctly and carried out with accuracy.
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. It is often indirectly said to any staff that will anticipate, carry out, or record information as a result of the call-out. Oftentimes, information that is called out is vital for next course of action in an emergency.
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. But, what is SBAR?
S-B-A-R is an abbreviation for Situation, Background, Assessment and Recommendation. These are the elements that are important to systematically and consistently give information on the clinical status of a patient. SBAR should be used when giving patient information between primary caregivers regardless of discipline.
The pertinent information that can be included will fit in the four elements of the S-B-A-R.
Situation is a brief description of the most recent clinical updates of the patient status, e.g., a most recent procedure or test done, current condition of patient, the most recent medication given prior to transfer.
Backgound is any information regarding familial or medical history of the patient that is pertinent to current care and patient condition.
Assessment is the information on the latest findings that reflect the most recent clinical status of the patient, i.e. vitals signs, blood test levels, device, appliance, equipment that is being used, current mental state, etc. The staff that is taking care of the patient must review the information with the other staff that will continue giving the care.
Recommendation is the information for future activities, assessment, or monitoring of the patient, for example, the frequency of vital signs, any monitoring to be done, or discharge plan.
The use of S-B-A-R is convenient and systematic. It is clear and simple. It should be use in all situations and in all aspects of patient care. SBAR can save lives in a split second, and avert any serious consequences that can jeopardize patient status.
To learn more about SBAR and the National Safety Goals, visit JACHO website.