Communication breakdown is a well-supported and well-documented contributing factor to errors. The Joint Commission has reported that communication breakdowns were the root cause of 65% of reported sentinel events in 2005.1 Seventy-three percent of those communication breakdowns resulted in patient death, the majority of which occurred during transition of care.2 The Joint Commission is focused on improving patient safety through its National Patient Safety Goal 02.02.01, which promotes a standardized communication methodology to improve hand-off communication.
This past summer, I facilitated a discussion on perioperative communication hand offs via Lippincott's Online Expo, a live event that offered perioperative, emergency, and telemetry nurses information on products, new regulations, and networking opportunities. I was gratified to see the response to the session and enjoyed chatting with other colleagues interested in this complex topic.
While the topic of perioperative hand-off communication is broad, the focus during the online session quickly leapt to the SBAR communication technique. SBAR is an acronym that stands for situation, background, assessment, and recommendation. During the situation phase, the communicator provides a synopsis of what's happening with the patient and when it started. Background information is provided to explain the events leading to the current situation. The communicator provides an assessment of the problem and any recommendations that may resolve the situation. Lastly, the receiver of the information is given time to ask questions and clarify the message.
A recent root cause analysis of reported events at my own institution revealed ineffective communication as a common factor. While our OR suite employs all of the above mentioned techniques, the organization has committed to making SBAR mandatory for all healthcare disciplines.
A team challenge
The OR setting has unique barriers to clear communication between team members. A desire to provide an efficient environment can lead to a hurried atmosphere. As perioperative nurses, we're all familiar with the distractions, sounds of equipment, muffled conversations behind surgical masks, and a host of other dynamics that may impede clear communication. Because each member of the operative team has a defined focus and role in patient care, communication can be one-dimensional. This type of communication can contribute to a lack of situational awareness, which means each team member knows what's going on.
Preoperative briefings, the safety checklist, and Universal Protocol are techniques used to diminish this type of ineffective communication and ensure the whole team is fully informed.
Let's take the lead
The perioperative nurse is in a unique position as the one team member with a global focus. While our practice is broad in scope, our principal role should be to promote effective communication. We can ensure that the whole team receives all of the pertinent patient information and the fine points needed to successfully perform the surgical procedure. As professionals, we can take the lead and implement these tools so that our patients are safeguarded against potential errors.
Elizabeth M. Thompson, RN, CNOR, MSN
Editor-in-Chief Nursing Education Specialist Mayo Clinic, Rochester, Minn. [email protected]
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