Communication: We do it hundreds of times per shift, over and over again, both professionally and personally. We do it electronically, over the phone, in person, verbally, and with our body language. And it is absolutely crucial to patient safety. 

At its most basic, communication is simply information passing between two people. But the sharing of information, especially in the medical field, is anything but simple. In fact, communication has often been identified as the most preventable way to avoid medical errors. Communication is absolutely paramount to patient safety, and was identified as one of the Joint Commission’s National Patient Safety Goals for the last several years. Root cause analysis of sentinel events often reveals that communication errors are a source of errors.

You can probably think back to a patient experience in your own practice that was affected by a miscommunication or a breakdown in information sharing. Have you ever had a patient tell you one thing, but tell the physician another story altogether? Have you ever received report on a patient who did not present at all as described by the off-going nurse? Have you ever been involved in a situation that arose because of a breakdown in communication between team members? Patient care teams are increasingly interdisciplinary, and communication is even more important when there are multiple providers caring for a patient. Complex relationships and dynamic care teams can present a challenge to even the best of communicators. 

Communication and information sharing is vital to safe patient care. What can you do as a nurse to improve your own communication skills? Below are some tips for avoiding errors and miscommunication in your practice.

1. Build relationships for effective teamwork.

Try to be an active team player on your unit and foster relationships between your colleagues, your management, and your physicians. Friendly encounters help foster mutual respect, which can help when two people communicate together.

2. Think of communication as a clinical skill.

It may seem that communication is a social skill, but if you look at it as a clinical skill, you may be able to step outside the dynamics of interpersonal relationships to effectively communicate.   

3. Use a systematic approach, such as SBAR.

SBAR, or Situation, Background, Assessment, and Recommendation, is a standardized communication tool that aims to present information in a logical, concise way for providers. It is a way of organizing information when providing handoff to another provider or calling a physician about a mutual patient. The use of SBAR can decrease miscommunication and errors, leading to safer patient care. You can read more about using SBAR at the Institute for Healthcare Improvement’s website

4. Close the loop.

Closed-loop communication, or “check back communication,” is when someone says something out loud, the responder repeats what they heard, and the original speaker confirms the understanding with a “yes.” This type of communication is specifically designed to reduce miscommunications. In patient codes or critical care, closing the communication loop can increase patient safety and leads to positive patient outcomes.

5. Clarify.

Trust your gut. If for any reason an order or directive seems strange for a patient, ask for clarification.

6. Report intimidating, rude, or unacceptable behaviors to supervisors.

If a member of your care team is rude to you, report this behavior to management. All care team members should be treated with respect. Mutual respect helps foster effective care relationships, and other behaviors can adversely affect patient care.

6. Be a good listener.

So much of good communication is not what you’re saying, but what you’re hearing. Remember that being a good communicator means that you are an excellent listener, both to what is being said but also to what is not said.  

7. Provide a strong hand-off report.

At change of shift, you are the expert on a particular patient’s plan of care, and you are handing over the patient to someone who has (usually) never seen the person before. Everything you say is important. Do your absolute best to give an organized, thorough report.

Laura Kinsella

Laura Kinsella, BSN, RN, CEN, is an emergency room nurse in Washington, DC.

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