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Clear communication--accept nothing less.

Nursing leaders continue to work with other disciplines to create a more patient-responsive health care system in the 21st century. Perhaps nothing that nurses and other providers do is more central to this effort than communication.

According to the Institute of Medicine (1999, 2001, 2003), ineffective communication among members of the health care team, patients, and families is the major cause of medical errors. Communication failure also accounted for more than 60% of the root causes of sentinel events reported to the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) since 1995 (JCAHO, 2007). JCAHO responded to this alarming trend by including effective communication among its National Patient Safety Goals. While the goals had previously addressed such "hot topics" of communication failure as abbreviation use and report of critical laboratory values, JCAHO most recently turned its attention to hand-off communication (Wilson, 2007, see page 201). In my own experience, this is indeed a time that is ripe for communication failure to occur.

Adding Advocacy

The JCAHO goal calls for a standardized approach to hand-off communication that in particular allows for the opportunity to ask and answer questions (JCAHO, 2006). Accurate, current information about a patient's care, condition, and recent or anticipated changes is essential to the continued safe provision of care. Some facilities have struggled a bit to formalize the hand-off process, perhaps discovering along the way that effective communication was not actually occurring at key points as the patient moved across the continuum of care. What can be done to improve the process?

First, nurses may need an adjustment in world view. We are truly not developing a standardized hand-off process because JCAHO requires it. We are doing this because it's an appropriate strategy to help ensure patient safety. We were all taught to serve as patient advocates, but that role sometimes gets lost in the shift's list of tasks. It should be evident in a powerful way when the nurse provides a hand-off report to another care provider. This is the opportunity for the nurse, who perhaps knows that patient better than anyone else, to give relevant, patient-centered information and to identify any perceived problems in caring for the patient. Doing this in front of the patient, either during a bedside report or "walking rounds," adds another layer of advocacy as the patient also has the opportunity to ask and answer questions about care.

Using Communication Tools

Second, nurses need to learn to be focused in their communication efforts. Giving report to another shift, for example, is typically learned on the job. This somewhat casual approach to shift report can result in missed orders or treatments, and can definitely jeopardize patient safety. One commonly offered guide for report is the acronym SBAR (situation, background, assessment, recommendation). SBAR and other tools like it can help nurses focus their communication efforts, especially in an urgent situation. These tools are not prescriptions, and they can definitely be modified to fit the needs of the health care providers who are using them, but they can help ensure that communication of good quality guides all patient care efforts. Preceptors should also evaluate the reporting style of their orientees and offer practical tips.

The goal is clear, concise communication for continued effective care. Nurses and other health care providers should accept nothing less from each other--for the sake of their patients.


Institute of Medicine (IOM). (1999). To err is human: Building a safer health care system. Washington, DC: National Academy Press.

Institute of Medicine (IOM). (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press.

Institute of Medicine (IOM). (2003). Keeping patients safe: Transforming the work environment of nurses. Washington, DC: National Academy Press.

Joint Commission on Accreditation of Healthcare Organizations (JCAHO). (2006). 2007 national patient safety goals. Retrieved April 24, 2007, from http:// res/98572685-815E-4AF3-B1C4-C31 B6ED22E8E/0/07_hap_npsgs.pdf

Joint Commission on Accreditation of Healthcare Organizations (JCAHO). (2007). Sentinel event statistics. Retrieved April 24, 2007, from http://www.jointcommis

Wilson, M.J. (2007). A template for safe and concise handovers. MEDSURG Nursing, 16(3), 201-206, 200.

Dottle Roberts, MSN, MACI, RN CMSRN, OCNS-C

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Author:Roberts, Dottie
Publication:MedSurg Nursing
Article Type:Editorial
Geographic Code:1USA
Date:Jun 1, 2007
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