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 showed 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 showed 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 decrease medical error and increase professionalism.

1 INTRODUCTION of incidents totally 249 reports about unhoped

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
incident and 238 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 caused
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
2 Chapter Error! No text of specified style in document.

not ambigous and accepted by the information about patient safety and interprofesional
receiver in order to decrease the errors and increse collaboration. Some of the designs used in this
the patient safety (The Commision of Hospital research are quantitative, qualitative, and Mixed
Accreditation, 2017 ). Methods.

Communication challenge among the health

service provider has limits in the difference of Figure 1. Flowchart of the systematic review process.
reporting system such as the doctor and nurse’s
role having diffence to document the result of
examination and intervention to the patient. The 8 relevant articles published
reporting structure of every different profession, from the database CINAHL,
the different perspective of profession culture Proquest, Pubmed, MEDLINE,
background, stress, tiredness, ethnical difference, Science Direct, and Gale from 2012
and social structure are regarded as a complicated to 2018. Clinical Key; 2 qualitative
factor of the implementation of a patient safety journals
based communication inter profession (Blom,
Petersson, Hegell & Westergen, 2015).
n=2
The effective collaborative communication Incomplete text
is an important element to give a qualified care and Does not match
increase the culture of patient safety. Meanwhile, the journal
vague ineffective communication among health title.
profession interprofessional becomes one of the
cause of the medication error such as the
medication error, unaccurate patient care program
and delays in transferring patients to critical care
(Leonard, Graham, & Bonacum, 2014).
Collaborative communication and teamwork are
16 articles related
important elements to provide quality care and
to topic above
patient safety (Leonard, Graham, & Bonacum,
2014). So based on the explanation of the above n=3
problems, researchers understand the importance Not related
of SBAR communication in interprofessional to SBAR
collaboration on patient safety in hospitals. This communication
study aims to determine the effect of SBAR and
communication in interprofessional collaboration interprofessional
on patient safety. collaboration.

2 METHOD
9 relevant articles
related to topic
The method used a literature review with
analyzes several relevant journals published from
the CINAHL, Proquest, Pubmed, MEDLINE,
Science Direct, and Gale databases. The keywords
used are SBAR communication, interprofessional
collaboration and patient safety. This search found
18 related articles. Of the 18 articles, there were
only 16 articles that focused on SBAR 3 RESULT
communication. Nine of the 16 focused articles
provided the full text of important information
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The research results that have been reviewed
are based on the inclusion and exclusion criteria,
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 provide. The better communication
that occurs between the two professions or other,
so that fore can provide the quality of services
better health (Elsous, Radwan, & Mohsen, 2017).
The research Chenjuan et al. (2018) 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.
The 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).
3
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 (95%) 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
communication 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
variable 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
World Health Organization (WHO) (2017),
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.
4 Chapter Error! No text of specified style in document.
Definition Communication SBAR 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) showed that communication SBAR
can be a framework for effective communication
between health team members regarding patient
conditions and patient safety. Similarly, another
study was performed by Funk et al. to establish a
structured handoff based on the SBAR framework
in the hospital post-anesthesia care unit. Over 50
handoff interactions were observed to assess the
completeness and comprehensiveness of verbal
communication and usability of the SBAR
document ISBARQ (introductions, situation,
background, assessment, recommendation, and
questions) checklist. The ISBARQ checklist was
associated with improvement in content
information of handover and increased the
provider’s satisfaction; however, there was no
significant change in duration of handover beetwen
doctor and nurses.
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%.
Based on the research Fabila (2016) showed
that with prospective interventional study, a total
of 52 CICU personnel participated in the study
which include 7 pediatric consultants, 1 rotating
pediatric registrar, and 44 nurses working in shifts
at KK Women’s and Children’s Hospital (KKH).
showed that the result There was a significant
increase in the proportion of nurses who indicated
that information transfer during verbal face-to-face
handover was frequently sufficient, as compared to
the pre-intervention phase (95.5 vs. 31.8%;
difference 63.7%; 95% CI 51.4–81.8%; p<0.0001).
Overall, the perceived usefulness of SBAR
document during handovers significantly increased
by about 33.0% (95% CI 15.0–53.0%; p=0.0004).
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).
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
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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).
Assessment of patient safety according to
research from various assessment indicators. The
result from Ting et al. (2017), The SBAR course
was offered as a 1-h session by management at Far
Eastern Memorial Hospital from 2012 to 2015. All
nurses were asked to answer the Safety Attitudes
Questionnaire (SAQ) before and after the
intervention with 6 safety dimensions of SAQ were
assessed which include teamwork climate, safety
climate, job satisfaction, stress recognition,
perception of management and working
conditions. Sample 29 nurses completed the pre-
intervention survey, 34 completed the first post-
intervention survey, and 33 completed the second
post-intervention survey. There was improvement
in the value ratings for teamwork climate
(p=0.002), safety climate (p=0.01), job satisfaction
(p=0.002), and working condition (p=0.02).
5 CONCLUSION
The conclusion of this research showed that:
1. Learning Approaches are collaborative doctors,
nurses, midwives, nutritionists, pharmacies,
physiotherapists, health services and other care
for patients.
2. The SBAR form is right for organizations that
allows transferring information from one
profession to another.
3. Professional interaction and performance to
improve the quality of patient care services.
4. Reducing medical error or human error.
5. Increasing professionalism. All health and
management service providers, doctors, nurses
and other teams.
6 SUGGESTION
Based on the results of the tests which have
been done, researchers suggest that research
research interventions for improving analysis of
the SBAR S implementation of the patients.
5
7 ACKNOWLEDGEMENT
The authors express their sincere gratitude
for all participants and their guardians. They thank
you too Universitas Sumatera Utara and Faculty of
Nursing Universitas Sumatera Utara for help and
publish this the research.
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