IMPROVE OF THE COMMUNICATION SBAR TO

COLLABORATION INTERPROFESIONAL TOWARD

PATIENT SAFETY WITH : A SYSTEMATIC REVIEW
Andriani Mei Astuti¹, Dewi Elizadiani Suza², Mahnum Lailan Nasution³
¹Master Students of Medical Surgical Nursing, ² Lecture Department of Pediatric Nursing, Faculty of
Nursing, ³Lecture Department of Mental Science Nursing, Faculty of Nursing, Universitas Sumatera Utara,
Prof. Maas Street Kampus USU, Medan, Indonesia
andrianimei90@gmail.com

Abstract

Background patient safety is the problem of priority to critical that develop into a systematic
movement to pressure the prevent medication error. Ineffective communication is a main factor in
medication error, the communication tool SBAR (situation, background, assessment and recommendation)
was developed to increase handover quality and to increase patient safety. The method used a systematic
review of articles published on SBAR and patient safety was performed in PUBMED, CINAHL,
MEDLINE, Proquest, Science Direct, and EMBASE from 2012 until 2018. That the search has found 18
articles related and out of the 18 articles, there are only 16 articles focusing on a communication sbar, 9 of
16 articles focused give complete text important information about patient safety and collaboration
interprofesional.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).
Communication SBAR between the doctors and nurses has a role to play that was important in ascertaining
the degree patient medical and quality of health services. Disscussion from the influence of the impact of
communication sbar interprofesional collaboration in having the value of the significant this shows that the
variable the communicators had a positive impact on patient safety to be hospitalised in hospital and will
improve the patient safety culture. The conclusion from this study shows that communication sbar is able
to make a collaborative approach doctor, nurses, midwife, nutritions, pharmacy, and another profession
associated in hospital. This review found moderate evidence for improved patient safety through SBAR
implementation, especially when used to structure communication over the phone.

Keywords : Communication SBAR, Interprofessional Collaboration, Patient Safety.

Department of Health, in its 2000 report an

1. INTRODUCTION
Patient safety had become the issue
that develops globally in health services,
patient safety is the problem of priority to
critical that develop into a systematic
movement to pressure the prevent
medication error (Smith et al., 2017).
National Patient Safety Agency (NPSA) in
2017 were collect data reported 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 human error and the mising
intervention.
Data from European Union Member
States, shows that consistently show that
medical errors and health-care related
adverse events occur in 8% to 12% of
hospitalizations. For example, the Germany
organisation with a memory, estimated
about 850 000 adverse events a year (10% of
hospital admissions). Spain (in its 2005
national study of adverse events) and France
and Denmark have published incidence
studies with similar results. Statistics show
that strategies to reduce the rate of adverse
events in the European Union alone would
lead to the prevention of more than 750 000
harm-inflicting medical errors per year,
leading in turn to over 3.2 million fewer
days of hospitalization, 260 000 fewer
incidents of permanent disability, and 95
000 fewer deaths per year (WHO, 2018).
In Indonesia, data reporting about
patient not safety incident shows that from
The Committe of Hospital Patient Safety
(KKP-RS) period September 2006-2011, the
data based on the kinds of incidents totally
249 reports about adverse events incident
and 238 reports injured near missing
incident. Meanwhile, based on the related
unit, nursery is about 238 reports, pharmacy 2. METHODS
is about 80 reports, laboratory is about 41
reports, doctor is about 33 reports and The method used a literature review
infrastructure is about 25 reports. The aim with analyzes several relevant journals
of patient safety has been formed and found published from the CINAHL, Proquest,
in the regulation of Indonesian Health Pubmed, MEDLINE, Science Direct, and
Minister (PERMENKES RI) No.11 year Gale databases. The keywords used are
2017 about the patient safety. and is also SBAR communication, interprofessional
found of the National Standard of Hospital collaboration and patient safety. This search
Accreditation (KARS). found 18 related articles. Of the 18 articles,
Miscommunication among the health there were only 16 articles that focused on
profession is reported as a cause factor SBAR communication. Nine of the 16
causing medication error, Joint Commision focused articles provided the full text of
International (JCI) shows the data 60% of all important information about patient safety
kinds of medical incidents is related to and interprofesional collaboration. Some of
communication (Vinu & Kane, 2016). the designs used in this research are
Communication is regarded to be effective if quantitative, qualitative, and Mixed
it is functual, accurate, complete and not Methods.
ambigous and accepted by the information Figure 1. Flowchart of the systematic
receiver in order to decrease the errors and review process.
increse the patient safety (KARS, 2017 ).
Communication challenge among the
health service provider has limits in the 8 relevant articles published from
difference of reporting system such as the the database CINAHL, Proquest,
doctor and nurse’s role having diffence to Pubmed, MEDLINE, Science
document the result of examination and Direct, and Gale from 2012 to 2018.
Clinical Key; 2 qualitative journals
intervention to the patient. The reporting
structure of every different profession, the
different perspective of profession culture
background, stress, tiredness, ethnical
difference, and social structure are regarded n=2
as a complicated factor of the
 Incomplete
implementation of a patient safety based text
communication inter profession (Blom,  Does not
Petersson, Hegell & Westergen, 2015). match the
journal title.
The effective collaborative
communication is an important element to
give a qualified care and increase the culture
16 articles related to
of patient safety. Meanwhile, vague
topic above
ineffective communication among health
profession interprofessional becomes one of
the cause of the medication error such as the n=3
medication error, unaccurate patient care
program and delays in transferring patients Not related to
to critical care (Leonard, Graham, & SBAR
Bonacum, 2014). Collaborative communication
communication and teamwork are important and
interprofessional
elements to provide quality care and patient
safety (Leonard, Graham, & Bonacum, collaboration.
2014). So based on the explanation of the
above problems, researchers understand the
importance of SBAR communication in
interprofessional collaboration on patient 9 relevant articles
safety in hospitals. This study aims to related to topic
determine the effect of SBAR
communication in interprofessional
collaboration on patient safety.
3. RESULT
The research results that have been
reviewed are based on the inclusion and
exclusion criteria, with quantitative,
qualitative and mixed method study designs.
Stating that communication between doctors
and nurses plays an important role in
determining the degree of health of patients
and the quality of health services they
provide. The better communication that
occurs between the two professions (doctor
and nurses), so that fore can provide the
quality of services better health.
Research comes from various
countries, with studies from Britain, India,
Republic of China, USA, Iran, Greece, Hong
Kong, Qatar and Indonesia. The study is
focused on the influence of SBAR
communication in interprofessional
collaboration on patient handling of patient
safety, so that it is hoped that it can reduce
the incidence of medication errors. The
results obtained are related to the SBAR
method, the hospital must be able to create
the same language standard to conduct
communication of patient care information.
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 effect of the differences of the
various variables on the safety of patients
has significant significance, this indicates
that communicator variables have a positive
effect on the safety of hospitalized 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) (2018) shows 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.
SBAR can play an important role in
communication between professions
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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