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Improve of the collaboration interprofessional toward patient

safety with communication SBAR : a systematic review


Andriani Mei Astuti¹, Dewi Elizadiani Suza², Mahnum Lailan Nasution³
¹Master Students of Medical Surgical Nursing, ²Head of Program Study, Faculty of Nursing,³Lecture
Department of Mental Science Nursing, Faculty of Nursing, Universitas Sumatera Utara,
Prof. Maas Street Kampus USU, Medan, Indonesia
andrianimei90@gmail.com

Keywords : Communication, SBAR, Patient Safety.


Abstract : Patient safety has been a global important issue, priority the patient safety is a developing
critical problem to be a systematic movement to pressure and prevent medication error. The
method used in this writing is literature review in which the researcher analyses some
relevant journals published from CINAHL, Proquest, Pubmed, MEDLINE, Science Direct,
and Gale database from 2012 until 2018. Keywords that it will be used in research sbar
communication, interprofesional collaboration and patient safety. This searching finds 18
related articles. From the 18 articles, there are only 16 focused to SBAR communication, 9
from the 16 articles are focused to give important complete texts about patient safety and
interprofessional collaboration. The result says that communication between a doctor and a
nurse has an important role to determine the degree of patient’s health and the quality of
health service. The impact to the SBAR communication effect in collaboration
interprofessional has a significat value, this indicates that communicator variable effects
possitively to the safety of inpatient patient at the hospital and can increase the culture of
patient safety. The conclusion of this study shows that SBAR communication can become
technique of doctor collaborative approach, nurse, midwife, nutritionist, physiotherapist and
other professions related to the health service rule to the patient. The form of SBAR
modified to the need of organization can play an important role to transform one profession
to others so that the relationship of interaction and collaboration among professions is an
important factor to increase the service quality of patient’s care,a decrease medical error and
increase professionalism.

1. INTRODUCTION reports about unhoped incident and 238


reports injured nearly incident. Meanwhile,
based on the related unit, nursery is about
Patient safety has been a global 238 reports, pharmacy is about 80 reports,
important issue, priority the the patient laboratory is about 41 reports, doctor is
safety is a developing critical problem to be about 33 reports and infrastructure is about
a systematic movement to pressure and 25 reports. The aim of patient safety has
prevent medication error (Smith et al., been formed and found in the regulation of
2017). National Patient Safety Agency Indonesian Health Minister (PERMENKES
(NPSA) in 2017 reported that there were RI) Number 11 year 2017 about the patient
135.356 incidents of medical error in safety and is also found in SKP 2 of the
England and increased significantly to be National Standard of Hospital Accreditation.
508.409 insidents in the period of January- Miscommunication among the health
March in 2018, the data showed that about profession is reported as a cause factor
44.000 - 98.000 people were dead every year causing medication error, Joint Commision
because of the medicine misgiving and the International (JCI) shows the data 60% of all
mising intervention. In Indonesia, data kinds of medical incidents is related to
reporting about unhoped incident and communication (Vinu & Kane, 2016).
injured nearly incident have not been Communication is regarded to be effective if
realized totally especially a private and it is functual, accurate, complete and not
remote hospital. The Committe of hospital ambigous and accepted by the information
patient safety (KKP-RS) for period receiver in order to decrease the errors and
September 2006-2011 mentioned the data increse the patient safety (The Commision
based on the kinds of incidents totally 249 of Hospital Accreditation , 2017 ).
Communication challenge among the Figure 1. Flowchart of the systematic review
health service provider has limits in the process.
difference of reporting system such as the
doctor and nurse’s role having diffence to
8 relevant articles published from
document the result of examination and the database CINAHL, Proquest,
intervention to the patient. The reporting Pubmed, MEDLINE, Science
structure of every different profession, the Direct, and Gale from 2012 to 2018.
different perspective of profession culture Clinical Key; 2 qualitative journals
background, stress, tiredness, ethnical
difference, and social structure are regarded
as a complicated factor of the n=2
implementation of a patient safety based
communication inter profession (Blom, Incomplete text
Does not match
Petersson, Hegell & Westergen, 2015).
the journal
The effective collaborative title.
communication is an important element to
give a qualified care and increase the culture
of patient safety. Meanwhile, vague
ineffective communication among health
profession interprofessional becomes one of 16 articles related to
the cause of the medication error such as the topic above
medication error, unaccurate patient care
program and delays in transferring patients
to critical care (Leonard, Graham, &
Bonacum, 2014). Collaborative n=3
communication and teamwork are important
elements to provide quality care and patient Not related to
safety (Leonard, Graham, & Bonacum, SBAR
2014). So based on the explanation of the communication
above problems, researchers understand the and
interprofessional
importance of SBAR communication in
collaboration.
interprofessional collaboration on patient
safety in hospitals. This study aims to
determine the effect of SBAR
9 relevant articles
communication in interprofessional related to topic
collaboration on patient safety.

2. METHODS
3. RESULT
The method used a literature review with
analyzes several relevant journals published from The research results that have been
the CINAHL, Proquest, Pubmed, MEDLINE, reviewed are based on the inclusion and
Science Direct, and Gale databases. The exclusion criteria, with quantitative, qualitative
keywords used are SBAR communication, and mixed method study designs. Stating that
interprofessional collaboration and patient safety. communication between doctors and nurses plays
This search found 18 related articles. Of the 18 an important role in determining the degree of
articles, there were only 16 articles that focused health of patients and the quality of health
on SBAR communication. Nine of the 16 focused services they provide. The better communication
articles provided the full text of important that occurs between the two professions (doctor
information about patient safety and and nurses), so that fore can provide the quality
interprofesional collaboration. Some of the of services better health.
designs used in this research are quantitative, The research Chenjuan et al. (2018)
qualitative, and Mixed Methods. provides empirical evidence that collaboration
(both interdisciplinary collaboration between
nurses and physicians and intradisciplinary
collaboration among nurses) as a unit work
environment factor is significantly associated
with two patient safety outcomes. Barriers to
effective communication included: (1) lack of
nurse skill in assessment and data collection (n = SBAR Communication consists of S
15), (2) time constraints (n = 6), (3) physician (Situation): a short statement of the problem that
attitude (n = 6), (4) communication skills of occurred at that time, B (Background): a
physicians and nurses (n = 4), (5) on-call medical statement from the information behind the
providers (n = 3), and (6) environmental noise (n situation, A (Assessment) statement of an
= 3). The facilitators of effective communication, assessment of a problem, R (Recommendation)
including nurse organization data, nurse statement about the act of asking for advice to
confidence in communication, and openness of take action to overcome the problem (Clochesy,
medical providers to communication conveyed. Dolansky, Hickman and Gittner, 2015).
Continuity of patient care with the transfer of
Effective communication between health detailed information about the information,
care professionals is inevitable and important clearly and summary of profession to other
factor in clinical decision making. The reason is professions. The lack of communication in health
that nurses, physicians and other healthcare care settings can cause serious medical errors and
professionals constantly face situations and can cause harm to patients and hospitals.
conditions that needs properly and on time Challenges in communication between health
communication (Muller et.al, 2018). SBAR services are different in training and expectations
communication used to enable information for reporting on different professions.
sharing between caregivers and doctors in The Institute for Healthcare
providing sustainable health services, and to Improvement (IHI) (2017) states that SARB
prevent the existence of communication communication can be a framework for effective
disparities between partners (McCrory, communication between health team members
Aboumatar, Custer, Yang, & Hunt, 2012). regarding patient conditions and patient safety.
The consistent use of SBAR also helps in SBAR Communication consists of S (Situation):
improving the quality of hospital services and is a brief statement of the problem that occurred at
able to increase patient trust (Blom, Petersson, that time, B (Background): a statement of the
Hagell, & Westergren, 2015). The effect of the information behind the situation, A (Assessment):
differences of the various variables on the safety a statement of an assessment of a problem, R
of patients has significant significance, this (Recommendation): statement about the act of
indicates that communicator variables have a asking for advice to take action to solve the
positive effect on the safety of hospitalized problem (Clochesy, Dolansky, Hickman &
patients and are able to improve the patient's Gittner, 2015). Stewart's research, et al. (2016)
safety culture. The results of a study of various showed that the communication component
commissions in patient safety showed that 75.6% situation (S) was mostly in the effective category
of staff were highly consistent in using SBAR as much as 82.0%, in the background
communication techniques, 21.8% in the form of communication component (B) most were in the
2.6% regular staff but using SBAR ineffective category of 78.0%, in the
communication techniques (Shahid & Thomas, communication component of assessment (A)
2018). mostly in the ineffective category as much as
64.0% and in the communication
recommendation (R) component category most of
4. DISCUSSION them are in the ineffective category as much as
64.0%. Communicating is considered effective in
a timely, accurate, complete, unambiguous, and
easily accepted manner by informants who aim to
The World Health Organization (WHO) reduce errors and improve patient safety
(2017) states that the implementation of (Commission for Accreditation in Hospital,
comprehensive health services must be discussed 2012). As is known that in the delivery of
jointly in detail and known by various parties messages there can be some obstacles, one of
related health services. The research from Shahid which is unclear speech and also supported by the
and Thomas's (2018) study said that same competencies of doctors, nurses and other
communication is the main key in medical teams. The use of medical terms in each
interprofessional collaboration, as mentioned in profession has different meanings and may not be
the results of research that there are significant understood by other professions, so that it can
effects of various communication variables on lead to errors in carrying out health care
safety safeguards with significant significance. interventions for patients and can affect patient
The results of this study show significant results safety (Randmaa, Martensson, Swenne, and
on the variable communication of patients with Engstrom, 2018). Positive collaboration of
safety that is 75.6% very strongly when using doctors has been shown to lead to better patient
SBAR communication techniques, 21.8% in the outcomes and increase the satisfaction of service
form of 2.6% would agree to always use SBAR delivery. The importance of research Anna, et al.
communication techniques. (2017) said that 78.0% of women had a good
attitude for collaborations with 30.2% of men (p
<0.001). Overall, 68.7% of nurses and 31.3% of
doctors had a good attitude towards collaborative improve communication in
care. Respondents of women had an average interprofessional rehabilitation teams.
attitude higher than 52.35 ± 6.30 compared to the
Journal of Interprofesisonal Care,
average score of 45.60 ± 7.18 (p <0.001).
The influence of understanding a January, 24(1) : Pg. 111-114.
communication not only in oral form, but also 10.3109/13561820902881601
documented in the notes of integrated
development, this is in the form of an integrated Blom, L., Petersson, P., Hagell, P., &
record of interprofessional patient care in the Westergren, A. (2015). The Situation,
hospital. Since patients include treatment of Background, Assessment and
patients with patients from hospitals, including Recommendation (SBAR) Model for
patient complaints, results of examinations, Communication between Health Care
planned management, instruction, analysis and Professionals: A Clinical Intervention
management evaluations provided to patients
including patient collaboration services. The Joint
Pilot Study. International Journal of
Commission International (JCI) (2017) states that Caring Sciences. Volume 8. Issue 3.
differences in verbal and telephone Page 530.
communication techniques also affect patient
safety, the medical team, especially nurses who Chaharsoughi, N., Ahrari, S., Alikhah, S.
receive verbal commands and the telephone (2014). A randomized trial comparison
always records the complete order of the patient's the effect of teaching of SBAR
examination results (write back), then reads back technique with role play and lecturing
(read back) and after that reconfirm (repeat back). on communication skill of nurses.
Journal of Caring Sciences, 3(2), 141-
5. CONCLUSION 147. doi: 10.5681/jcs.2014.015.
This study shows that the learning
approach is collaborative doctors, nurses,
midwives, nutritionists, pharmacy, Cunningham, N., Weiland, T., Dijk, J.,
physiotherapists, health related in service
Paddle, P., & Shilkofski, N. (2012).
management and other professions for patients.
Forms of SBAR which are modified for Telephone referrals by junior doctors: a
organizational needs can play an important role in randomised controlled trial assessing
transferring information from one profession to the impact of SBAR in a simulated
other professions. SBAR can play an important setting. Postgrad Medical Journal; 7
role in communication between professions (1) 619–626. doi:
regarding the status of progress of patients 10.1136/postgradmedj-2011-130719
through patient integrated patient development
records. Safety of heavy dependent on the actions Institute for Healthcare Improvement.
taken by the medical team, so that interaction and (2017). SBAR: Situation-Background-
professional collaboration are important factors to Assessment-Recommendation
improve the quality of patient care services,
reduce medical errors, and improve Joint Commission International. (2017). JCI
professionalism.
Accreditation Standards for
All health care providers and
management evaluate SBAR communication hospitals.6th Edition.
techniques that have been carried out, motivating
Joffe E., James P., Turley., Kevin, O., Todd,
to carry out SBAR communication techniques
and interactions with doctors, nurses and other R., Craig, W., Elmer, V. (2013).
teams. Establish training programs on patient Evaluation of a problem - specific
safety management based on effective SBAR tool to improve after - hours
communication and SBAR. nurse - physician phone
communication: A randomized trial.
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