As a staff nurse,
Patient safety a common goal for us, one of the major issues for safety is
medication error due to lack of effective communication among the healthcare.
The incident of medication error appears to be increasing. As medication error
is seen that complicated order was the factor contributing to the medication
error, I wish to reflect on poorer communication skills training between
healthcare indicate of medication error. It is an important indicator of the health
care delivery system because of potential injury to the patients (Benjamin DM,
2003). Over 2 million serious ADRs requiring hospitalization, causing permanent
disability or death occurs each year (Dellamin Che Abdullah, Noor Shufiza
Ibrahim and Mohamed Ibrahim, 2004). In Malaysia, 2572 cases of medications were
reported and it was identified as main adverse event issues that impacted on
patient outcomes in 2009 (Maziah AM, Wichaikhum O, Nantsupawat R, 2012).
Communication can be
defined as a process during which information is shared through the exchange of
verbal and non-verbal messages ( Brooks and Heath 1985), and where people
create a relationship by interacting with each other ( Groogan 1999).
Communication is integral to the nurses- patient relationship and is one of the
six fundamental values of nursing identified in government’s strategy to
deliver high-quality, compassionate care for patients(Department of
Health(DH)2012).Good communication skills is a bridge between healthcare and
patient to communicate and to prove better care, good communication is one of
the most important aspects of nursing care as it pervades every part of the
nurse-patient relationship(Heaven & Maguire,1996).
The nursing process
moreover as a scientific method of exercise and implementation of nursing, is
achieved through dialogue, through the interpersonal environment and with
specific skills of verbal communication. (Raya A. basic Nursing, 2005).
Methods of communication
Effective communication needs knowledge of good verbal and
nonverbal communication skill and techniques. Verbal communication comes in the
format spoken language, it can be formal or informal in its delivery. Verbal
language is one of the main ways in which we communicate it can be by face to
face, telephones, radio or television.
Nonverbal communication is a communicate using visual cues
such as body language, facial expression, body posture, gesture, pitch, speed
tone and volume of voice, and attire.
Written communication involves any types of interaction that
makes use of the written words as a communication mediated in facts, written
communication is the most common form of nursing communicates in healthcare
services. Nurses need to keeps good written (documentation) records of patient
details, treatment and nursing care that performed as an evidence and for
Visualization communication requires the use of visual aids
which are read or viewed for ideas and information to communicate such as
graphs, charts, maps, books, posters and screen-based media. Visual
communication playing an important role in this era, the reason is, it helps to
grab the attention of receiver and ensures them retain in delivery information.
Barriers to effective communication
Effective communication means transferring message by
keeping in mind the understanding or ability of receiver and to make sure the
receiver will be able to understand the meaning of the message or information.
An understanding of barriers to communication is also very
important. The Welsh Assembly’s fundamentals of care (2003) showed that many of
problems associated with health and social care were due to failure in
communication. Environment barrier such as high workload, lack of time, lack of
support, staff conflict, lack of privacy or lack of referral pathways. Fear and
anxiety related to making the patient more distressed by talking or asking
difficulty question. Other barriers not having the skills or strategies to cope
with difficult reaction, questions or emotions. Thinking “it is not my
role” and “the patient is bound to be upset”. Raising awareness
of the barriers to effective communication, possibility to manage and minimise
the effect of these barriers in the clinical area.
The deception simple concept called Active Listening is one
of importance method of improving effective communication among health cares.
By practice Active Listening, nurses can be attentive to the needs of the
patients and provide cares according to the patients evolving needs. Using a
respectful tone can bound a good relationship. Maintaining eye contact, it can
provide a sense of emotional connection and significant attention toward
communication. Avoiding jargon and acronyms, special words or expression by
profession or group that are difficult for others to understand the especially
medical jargon. Use simple language can motivate receiver for better
Simple strategies can easily impart critical information
just by eyesight. For instance, nurses are able to communicate critical patient
status issues like allergic and fall risk with color-coded patients
identification wristbands or stickers on their medical record, a seat belt or
flag attached to a wheelchair or any other objects which are easily
identifiable by all medical practitioner (join contribution resources, 2005).
The use of local jargon can also be avoided when making professional
conversation because some words may portray a meaning that was not intended or
is not readily understood by a large number of people.
Assimilation of the SBAR tool is a strategy that has been
really helpful in enhancing communication in the healthcare sector when used.
Availability of the situation (S) about what is the current situation, ongoing
investigation, family situation and how much patients or client Aknows about
the condition. Background (B) about give the patient or client reasons for or
date of admission, significant past medical history. Assessment (A), medical
assessment finding or concerns, involvement, and progress. Recommendation (R),
a suggestion for treatment. Facilitates communication allowing each health
practitioner to receive and giving important information in a format that
satisfies numerous communication styles and needs (Dixon et. 2006). This tool
should adopt by everyone to improve communication between healthcare
professionals, clinical s and nursing staff and is because this technique
utilizes the use of one common language for passing on critical information
without leaving out anything and increase patient safety.
The introduction of computerized systems in the hospital has
exchanges the working practices. Patient’s data is stored on this system, which
can be used to manage patient list, appointment, and issues of prescriptions.
This usually faster, more reliable and more accurate than performing the task
manually. The computer system is a money saving and reduces the workloads of
staff nurses and healthcare. Computer prescribes order entry system (CPOE)
designed to decrease medication errors by improving the prescribing aspects of
the medication systems. The advantages of this system are the elimination of
handwriting discrepancies. It also can identify error checking for dosage,
frequency, route of administration and drug interaction or allergy checking.
Medication audit for healthcare is ways of measuring and
monitoring practice which promote high-quality care. In 1854 Florence
Nightingale used the audit to prevent postsurgical mortality. Audit and
feedback seem to be an effective source of tool and guidelines for evaluation
actual performance and planning corrective action to prevent or reduce the risk
of medication error.
Some medication carries a higher risk and harm than other
medications and error in the administration of this kind medication can cause
life threating to the patients. This kind medication is identified as a high
alert medications (HAM) and required special consideration. To ensure safe
medication error that, nurses implement double checking with senior nurses or
physician and use of HAM sticker to ensure awareness during handling with kind
medication. During serving medication nurses should identify correctly patient
by asking full name, date of birth and identity card number. Used of (5Rs)
right drug, right dose, right time, right route and the right patient can
prevent medication error.
In conclusion, nurses, patients, and healthcare communication
are arts, requiring not only the expertise of nurses but also extensive
knowledge of the good communication skills .for nurses, achieving nursing
profession is a communication basic skill. Medication error is a major issue in
the healthcare industry, it is still preventable if all healthcare and nurses
take apart. By improving effective communication skills the nurses and
healthcare professionals can deliver good patient’s care, improving patient’s
safety and enriched effective nursing cares. Healthcare Management should take
part and provide courses and training to increase the nurses and healthcare
knowledge and competency on communication and medication. By doing this, they
will aware of the safety of patients.