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 Administration of Nursing, ²Head of Program Study, Faculty of Nursing,³Lecture
Department of Mental Health 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 issued, priority the patient safety is a developing
critical problem to be a systematic movement to pressure and prevented medication error.
The method used in this writing is literature review in which the researcher analyzing 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

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

The method used a literature review 3. RESULT

with analyzes several relevant journals
published from the CINAHL, Proquest, The research results that have been
Pubmed, MEDLINE, Science Direct, and reviewed are based on the inclusion and
Gale databases. The keywords used are exclusion criteria, stating that
SBAR communication, interprofessional communication between doctors and nurses
collaboration and patient safety. This search plays an important role in determining the
found 18 related articles. Of the 18 articles, degree of health of patients and the quality
there were only 16 articles that focused on of health services provide. The better
SBAR communication. Nine of the 16 communication that occurs between the two
focused articles provided the full text of professions or other, so that fore can provide
important information about patient safety the quality of services better health (Elsous,
and interprofesional collaboration. Some of Radwan, & Mohsen, 2017).
the designs used in this research are
quantitative, qualitative, and Mixed The research Chenjuan et al. (2018)
Methods. provided 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 =
15), (2) time constraints (n = 6), (3)
physician attitude (n = 6), (4)
communication skills of physicians and
nurses (n = 4), (5) on-call medical providers
(n = 3), and (6) environmental noise (n = 3).
The facilitators of effective communication,
including nurse organization data, nurse
confidence in communication, and openness
of medical providers to communication
conveyed.
Results revealed that barriers to their
work as an interprofessional team included
time, space, financial issues and
Assumptions of hierarchy. Issues associated
with time and space have been identified by
others as structural factors relevant to
effective interprofessional care (Stetten et.al,
2018). Effective communication between
health care professionals is inevitable and
important factor in clinical decision making.
The reason is that nurses, physicians and
other healthcare professionals constantly
face situations and conditions that needs
properly and on time communication
(Muller et.al, 2018). SBAR communication
used to enable information sharing between
caregivers and doctors in providing
sustainable health services, and to prevent
the existence of communication disparities
between partners (McCrory, Aboumatar,
Custer, Yang, & Hunt, 2012).
The consistent use of SBAR also helps in
improving the quality of hospital services
and is able to increase patient trust (Blom,
Petersson, Hagell, & Westergren, 2015).
The percentage of time spent on shift
report tasks was 54.6% during baseline and
62.7% and 66.4% in the SBAR conditions.
These differences were significant showing
an increase in percentage Ninety-five
percent of shift reports included at least
some time on nonYshift report tasks. The
time spent in verbal c es have a positive
effect on the safety of hospitalized
ommunication as a percentage of the total
shift report was 29.5% during baseline and
42.1% in the proccess. This difference was
significant in the ANOVA (F = 11.48),
indicating the amount of verbal
communication was higher with SBAR.
Writing during the shift report decreased
from 21.1% to 11.2% with the paper SBAR
but increased to 22.9% with the electronic
SBAR. The SBAR protocol and report help
accomplish communication goals and
improve shift reported and can set the stage
for improved communication between
nurses and staff (Cornell et al, 2013). The
effect of the differences of the various
variables on the safety of patients has
significant significance, this indicates that
communicator variabl patients and are able
to improve the patient's safety culture. The
results of a study of various commissions in
patient safety showed that 75.6% of staff
were highly consistent in using SBAR
communication techniques, 21.8% in the
form of 2.6% regular staff but using SBAR
communication techniques (Shahid &
Thomas, 2018).
4. DISCUSSION
The World Health Organization
(WHO) (2017) states that the
implementation of comprehensive health
services must be discussed jointly in detail
and known by various parties related health
services. The research from Shahid and
Thomas's (2018) study said that
communication is the main key in
interprofessional collaboration, as
mentioned in the results of research that
there are significant effects of various
communication variables on safety
safeguards with significant significance. The
results of this study show significant results
on the variable communication of patients
with safety that is 75.6% very strongly when
using SBAR communication techniques,
21.8% in the form of 2.6% would agree to
always use SBAR communication
techniques.
SBAR Communication consists of
S (Situation): a short statement of the
problem that occurred at that time, B
(Background): a statement from the
information behind the situation, A
(Assessment) statement of an assessment of
a problem, R (Recommendation) statement
about the act of asking for advice to take
action to overcome the problem (Clochesy,
Dolansky, Hickman and Gittner, 2015).
Continuity of patient care with the transfer
of detailed information about the
information, clearly and summary of
profession to other professions. The lack of
communication in health care settings can
cause serious medical errors and can cause
harm to patients and hospitals. Challenges in
communication between health services are
different in training and expectations for
reporting on different professions.
The Institute for Healthcare
Improvement (IHI) (2017) states that SARB
communication can be a framework for
effective communication between health
team members regarding patient conditions
and patient safety. SBAR Communication
consists of S (Situation): a brief statement of
the problem that occurred at that time, B
(Background): a statement of the
information behind the situation, A
(Assessment): a statement of an assessment
of a problem, R (Recommendation):
statement about the act of asking for advice
to take action to solve the problem
(Clochesy, Dolansky, Hickman & Gittner,
2015). Stewart's research, et al. (2016)
showed that the communication component
situation (S) was mostly in the effective
category as much as 82.0%, in the
background communication component (B)
most were in the ineffective category of
78.0%, in the communication component of
assessment (A) mostly in the ineffective
category as much as 64.0% and in the
communication recommendation (R)
component category most of 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 reduce errors and
improve patient safety (Commission for
Accreditation in Hospital, 2012). As is
known that in the delivery of messages there
can be some obstacles, one of which is
unclear speech and also supported by the
same competencies of doctors, nurses and
other medical teams. The use of medical
terms in each profession has different
meanings and may not be understood by
other professions, so that it can lead to errors
in carrying out health care interventions for
patients and can affect patient safety
(Randmaa, Martensson, Swenne, and
Engstrom, 2018). Positive collaboration of
doctors has been shown to lead to better
patient outcomes and increase the
satisfaction of service delivery. The
importance of research Anna, et al. (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 care. Respondents of
women had an average attitude higher than
52.35 ± 6.30 compared to the average score
of 45.60 ± 7.18 (p <0.001).
The influence of understanding a
communication not only in oral form, but
also documented in the notes of integrated
development, this is in the form of an
integrated record of interprofessional patient
care in the hospital. Since patients include
treatment of patients with patients from
hospitals, including patient complaints,
results of examinations, planned
management, instruction, analysis and
management evaluations provided to
patients including patient collaboration
services.
The Joint Commission
International (JCI) (2017) states that
differences in verbal and telephone
communication techniques also affect
patient safety, the medical team, especially
nurses who receive verbal commands and
the telephone always records the complete
order of the patient's examination results
(write back), then reads back (read back)
and after that reconfirm (repeat back).
5. CONCLUSION
This study shows that the learning
approach is collaborative doctors, nurses,
midwives, nutritionists, pharmacy,
physiotherapists, health related in service
management and other professions for
patients. Forms of SBAR which are
modified for organizational needs can play
an important role in transferring information
from one profession to other professions and
regarding the status of progress of patients
through patient integrated patient
development records. Safety of heavy
dependent on the actions taken by the
medical team, so that interaction and
professional collaboration are important
factors to improve the quality of patient care
services, reduce medical errors, and improve
professionalism. All health care providers
and management evaluate SBAR
communication techniques that have been
carried out, motivating to carry out SBAR
communication techniques and interactions
with doctors, nurses and other teams.
Establish training programs on patient safety
management based on effective
communication and SBAR.
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