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Communication problems Inadequate information flow
Human problems
Patient-related issues Organizational transfer of knowledge
Staffing patterns/work flow
Technical failures Inadequate policies and procedures
(AHRQ Publication No. 04-RG005, December2003) Agency for Healthcare Research and
Quality
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1. Communication
2. Patient Assessment
3. Procedural Compliance
4. Environmental Safety/Security
5. LeadershipSources: Michael S. Woods, M.D., How Communication Complicates the PatientSafety Movement, Patient Safety & Quality Healthcare, May/June 2006; Joint
Commission on Accreditation of Healthcare Organizations, 2006; H&HN
research, 2006
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STIMULUS
ENCODER
STIMULUS
DECODERUMPAN BALIK
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The Joint Commission for Accreditation forHealth Organization has listed effectivecommunication as goal no.2 of the 2006National Safety Goals.
Effective communication depends on clarity: thespeaker must convey his or her message insuch a way that the listener clearly understandsthat message.
But the truth is communication is influenced by a
host of factors: gender, ethnicity, culture,professional dynamics. So a speakers intendedmessage may not be what the listener hears orunderstands, which can compromise patientsafety.
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Effective communication must meet certainstandard when delivering information from thesender to the receiver. Information that is beingcommunicated must be clear and easily
understood. Some buzzwords are confusing andmight lead to misunderstanding, so use it withcaution.
Effective communication must be complete. All
pertinent information must be said with lessunnecessary details. Too much use of the detailscan also confuse the receiver instead of helpingone to understand.
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Timeliness of giving the information is
important especially when communicatingwith patient care related issues. Timelinessalso gives a true sense of urgency. Anydelays in patient-related communicationwill often lead to patient beingcompromised.
The information communicated must beacknowledged and verified by the receiverin order for the exchange of information tobe effective.
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Improved communication is one of the Joint Commissions 2006National Patient Safety Goals. JCAHO requires organizations to
establish processes that will help eliminate communication errors, such
as:
Have individuals verify verbal and telephone orders and critical test
results by reading back the complete order or test result.
Standardize a list of abbreviations, acronyms and symbols that are
not to be used throughout the organization.
Measure, assess and, if appropriate, take action to improve the
timeliness of reporting, and the timeliness of receipt by the
responsible licensed caregiver, of critical test results and values. Implement a standardized approach to hand off communications,
including an opportunity to ask and respond to questions.
Source: Joint Commission on Accreditation of Healthcare Organizations, 2006; H&HNresearch, 2006
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1. Culture/Ethnicity
A patients culture may influence how he or she interacts
with caregivers. Language barriers can cause
misunderstandings and miscommunications.2. Socioeconomics
Levels of education, literacy, economics, beliefs and
behaviors can differ tremendously among patients, can
affect the ability of staff to communicate with one another(e.g., nurses and doctors) and can lead to
miscommunication.
3. Literacy
How well does the patient understand medical terms? Canthe patient follow take-home instructions?
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4. Gender Gender influences relationships among staff and
between caregivers and patients.
5. Personality/Behavior
Individuals personalities color their dailycommunication and influence how others perceivethem.
Urgency affects a speakers tone. For example, ahurried doctor or a stressed-out nurse may be perceivedas curt by the patient or other staff.
Sources: Michael S. Woods, M.D., How Communication Complicates the Patient Safety Movement, Patient Safety &Quality Healthcare, May/June 2006; H&HN research, 2006
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Lack of structure, policies, and proceduresrelated to the content, timing, or purpose ofverbal reports.
No shared mental model or framework for verbal
healthcare communication. No rules for verbal transmission of information,
either face-to-face or over the telephone.
Differing opinions, even among nurses, as to
what information should be communicated duringa verbal report.
Frequent interruptions and distractions.
Frequency of communication.
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KOLABORASI
AREA KELABU PADAT RISIKO/ ERROR
( PELIMPAHAN SECARA TERTULIS / STANDING ORDER dan
SESUAI KOMPETENSI)
PRAKTIK
KEPERAWATANPRAKTIK
KEDOKTERAN
PERAWAT DOKTER
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For verbal or telephone orders
For reporting critical results
Method:
The individual receiving the information Writes down the complete order or test result, or
Enters it into the computer
The individual receiving the information
Reads back what has been written
The individual who gave the order
Verifies the correctness
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Check-back is a good way to verify
information especially when transcribing
a doctors order.
Medical orders must be reviewed forcompleteness and clarity.
The medical orders must be questioned
if penmanship is illegible orabbreviations are used that are not
acceptable by the institution.
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Call-out is another technique when
a critical information is called out
during an emergency situation.
The critical information is said aloud
so that any team members present
during an emergency that are
hearing and listening to theinformation.
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Hand-off is another technique of verbally transferringinformation, responsibility, and accountability of patient care
to another staff.
This includes the review of written report on the pertinent
patient information, the latest significant changes in patientstatus, and the latest recommendation on the plan of care.
The receiving staff has to acknowledge the completeness,
pertinence of information, and accepts the responsibilities
in providing patient care. Using the S-B-A-R method in hand-off will enhance
communication and promote a culture of patient safety.
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S-B-A-Ris an abbreviation for : Situation,
Background, Assessment and
Recommendation.
Giving information systematically andconsistently
SBAR should be used when giving patient
information between primary caregiversregardless of discipline.
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SBAR is a technique that
provides a framework.
easy-to-rememberallows for an easy and focused
way to set expectations
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Communication Tools :
SBAR Situation:What is going on with the patient?
What is happening at the present time?
Background:What are the circumstancesleading up to this situation?What is the clinical
background? Assessment:What is the problem? What is
the current situation?
Recommendation:What should be done to
correct the problem?------- Response/Repeat back: Repeat back the
plan of care
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S : Situation
Kondisi terkini yg terjadi
pada pasien
B : Background
Informasi penting apa ygberhubungan dg kondisi
pasien terkini
A : Assessment
hasil pengkajian kondisi
pasien terkini
R : Recommendation
apa yg perlu dilakukan
Untuk mengatasi masalah
Dapat digunakan
saat serah terimaperawat antar
shift, perawat ke
doktersaat
melaporkankondisi pasien,
dokter ke dokter.
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S SITUATION
-nama. Umur, tgl masuk, hari
perawatan, dr yg merawat- diagnosa medis dan masalahkep yg belum dan sdh teratasi
B BACKGROUND- keluhan uatama, intervensi ygtelah dilakukan, respon psn diagnosa kep.
- riwayat alergi, rwyt pembedahan,pemasangan alat invasif dan obat/infuus
- pengetahuan pasien/ kel D/ medis
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AASSESSMENT
- jelaskan hasil pengkajian pasienterkinitanda vital, pain score, tkkesadaran, status restrain, risiko
jatuh, status nutrisi, eliminasi, halyg kritis, dll.
- hasil investigasi yg abnormal- informasi klnik lain yg mendukung
RRECOMMENDATION- rekomendasi intervensi keperawatan
yg perlu dilanjutkan ( refer ke nursingcare plan) termasuk discharge
planning- edukasi pasien/ keluarga
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example
S = Dr. Smith, this is Mary at General Hospital
calling regarding Mr. Cook in 212. His temperature is up to 103.5.
B = He is POD #2 S/P right knee replacement.
A = The wound is red; pulse is up to 115 from baseline of 80; his
pain level has increased to 9/10 despite increasing his Vicodin dosingto ii tabs Q4.
Specific numerical values are given in the assessment
R = I would like you to come see him. When can I expect you?
Asking for a specific time frame
R = I will be there in 15 minutes, I am in the PACU.
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MENINGKATKAN KOMUNIKASI PADA
SAAT OPERAN / HAND- Off
GUNAKAN BAHASA YANG JELAS
GUNAKAN TEHNIK KOMUNIKASI YGEFEKTIF : kurangi interupsi, alokasikan
waktu yg cukup , terapkan read backataucheck backtehnik,
Standarisasi laporanantar shift / antar unit
Saat transisi ==> pasien mau pulang/
pindah, berikan informasi yg jelas kpdpasien/ kel: obat, diagnosa pulang,hasil pemeriksaan, kapan dan dimanakonsultasi fo llow up
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Standardized abbreviations, acronyms,
symbols, and dose designations
Do Not Use list
Do not use in medication orders
Do not use in medication-related
documentation
Do not use on pre-printed forms
Do not use in handoff communications to
other providers
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Limit Abbreviations The Joint Commission has a list of abbreviations that should not be used
on orders or on any medication-related documentation that is handwrittenor on preprinted forms. The list below provides the following substitutions:
JCAHO Do Not Use List
*Exception: Use a trailing zero where required to demonstrate the level of precision of the value being reported,such as for laboratory results. It may not be used in medication orders or other medication-relateddocumentation.
Source: Joint Commission on Accreditation of Healthcare Organizations, 2006; H&HNresearch, 2006
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Poor handwriting
Lotrison or Lotrimin ? Coumadin or Kemadrin ?
Doxorubicin or Daunorubicin ? Pentobarbital or Phenobarbital ?
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