2Objectives Describe the importance of communication Recognize the connection between communication and medical errorDefine communication and discuss the standards of effective communicationDescribe strategies for information exchangeIdentify barriers, tools, strategies, and outcomes to communication
4Importance of Communication Ineffective communication is a root cause of nearly 66 percent of all sentinel events reported** (The Joint Commission Root Causes and Percentages for Sentinel Events (All Categories) January 1995−December 2005)
5Communication is…The process by which information is exchanged between individuals, departments, or organizationsThe lifeline of the Core TeamEffective when it permeates every aspect of an organizationAssumptionsFatigueDistractionsHIPAA
6Standards of Effective Communication CompleteCommunicate all relevant informationClearConvey information that is plainly understoodBriefCommunicate the information in a concise mannerTimelyOffer and request information in an appropriate timeframeVerify authenticityValidate or acknowledge information
9SBAR provides…A framework for team members to effectively communicate information to one anotherCommunicate the following information:Situation―What is going on with the resident?Background―What is the clinical background or context?Assessment―What do I think the problem is?Recommendation―What would I recommend?Remember to introduce yourself.
11SBAR Exercise Create an SBAR example based on your role. Situation – What is happening?Background – What is the background?Assessment – What do I think the problem is?Recommendation – What would I recommend?
12Call-Out is…A strategy used to communicate important or critical informationIt informs all team members simultaneously during emergency situationsIt helps team members anticipate next steps…On your unit, what information would you want called out?
14HandoffThe transfer of information (along with authority and responsibility) during transitions in care; to include an opportunity to ask questions, clarify, and confirm
15Handoff Optimized Information Responsibility–Accountability UncertaintyVerbal StructureChecklistsIT SupportAcknowledgmentGreat opportunity for quality and safety
16Question, Clarify, and Confirm “I PASS THE BATON”Introduction: Introduce yourself and your role/job (include resident)Patient/Resident: Identifiers, age, sex, locationAssessment: Relevant diagnoses and complaints, vital signs and symptomsSituation: Current status (e.g., ADL status, intake, elimination, behavior, cognition), including code status, level of uncertainty, recent changes, and response to treatmentSafety: Critical lab values/reports, allergies, and alerts (falls, isolation, etc.)THEBackground: Other diagnoses, previous episodes, current medications, historyActions: What actions were taken or are required? Provide brief rationaleTiming: Level of urgency and explicit timing and prioritization of actionsOwnership: Who is responsible (nurse/doctor/APRN/nursing assistant)? Include patient/family responsibilitiesNext: What will happen next? Anticipated changes? What is the plan? Are there contingency plans?Question, Clarify, and Confirm
17Communication Challenges Language barrierDistractionsPhysical proximityPersonalitiesWorkloadVarying communication stylesConflictLack of information verificationShift changeGreat Opportunity for Quality and Safety
18Barriers to Team Effectiveness Inconsistency in Team MembershipLack of TimeLack of Information SharingHierarchyDefensivenessConventional ThinkingComplacencyVarying Communication StylesConflictLack of Coordination and Followup With Co-WorkersDistractionsFatigueWorkloadMisinterpretation of CuesLack of Role ClarityTOOLS and STRATEGIESBriefHuddleDebriefSTEPCross-MonitoringFeedbackAdvocacy and AssertionTwo-Challenge RuleCUSDESC ScriptCollaborationSBARCall-OutCheck-BackHandoffOUTCOMESShared Mental ModelAdaptabilityTeam OrientationMutual TrustTeam PerformanceResident Safety!!
19Teamwork ActionsCommunicate with team members in a brief, clear, and timely formatSeek information from all available sourcesVerify and share informationPractice communication tools and strategies daily (SBAR, call-out, check-back, handoff)