Communicating for Safety Standard

Background to this standard

Communication is a key safety and quality issue, and is critical to the delivery of safe patient care. Communication failures, and inadequate or poor documentation of clinical information can result in errors, misdiagnosis, inappropriate treatment and poor care outcomes.^1,2,3,4-7 Communication errors are also a major contributing factor in sentinel events in health service organisations⁸, and communication issues are identified as one of the most common underlying factors in complaints about the Australian healthcare system.^9-11

This standard recognises the importance of effective communication in health care and the essential role that communication plays in ensuring safe, coordinated and continuous care. Actions in this standard focus on three high-risk areas where communication is critical to patient safety:

• When patient identification and procedure matching should occur
• When all or part of a patient’s care is transferred within an organisation, between multidisciplinary teams and clinicians, across organisations and on discharge (that is, at transitions of care)
• When critical information or risks emerge or change throughout the course of care.

Contemporaneous documentation and recording of information that supports the provision of health care are also essential.

Communication is inherent to patient care, and informal communications will occur throughout care delivery. This standard is not intended to apply to all communications within the organisation. Rather, it aims to ensure that systems and processes are in place at key times when effective clinical communication and documentation are critical to patient safety.

This standard specifically outlines the high-risk situations when effective communication is critical to ensure safe, continuous patient care. The standard requires health service organisations to implement systems and processes to support effective clinical communication and documentation.

This standard is informed by research and work undertaken in Australia and internationally, which recognises the importance of effective clinical communication and documentation to the delivery of safe and high-quality health care.^3,6,7 This includes work by the Commission on the Ensuring Correct Patient, Correct Site, Correct Procedure Protocol; the National Clinical Handover Initiative Pilot Program; the OSSIE Guide to Clinical Handover Improvement, and the Implementation Toolkit for Clinical Handover Improvement. The Commission has also supported research on improving transitions of care, patient–clinician communication and documentation.

Links with other standards

Communication is important across all aspects of care. Implementation of this standard will depend on the organisation-wide systems required under the Clinical Governance Standard and the Partnering with Consumers Standard. These two standards set the overarching requirements for effective implementation of actions within this Communicating for Safety Standard. There are also strong links with actions in the Medication Safety Standard, the Comprehensive Care Standard, and the Recognising and Responding to Acute Deterioration Standard. If appropriate, these standards should be applied in conjunction with this standard.

For example, the Clinical Governance Standard requires organisations to integrate multiple information systems, where they are used (Action 1.16e), and have in place a healthcare record system that makes the healthcare record available to clinicians at the point of care (Action 1.16a). By ensuring that clinicians have access to all the relevant information, these actions support clinicians to effectively communicate. In turn, this standard requires organisations to have systems to contemporaneously document relevant information in the healthcare record, ensuring that the most up-to-date information is available to clinicians.

References

1. Leonard M, Graham S, Bonacum D. The human factor: the critical importance of effective teamwork and communication in providing safe care. Qual Saf Health Care 2004;13(Suppl 1):i85–90.
2. Mitchell P, Wynia M, Golden R, McNellis B, Okun S, Webb CE, et al. Core principles and values of effective team-based health care. Discussion paper. Washington (DC): Institute of Medicine; 2012.
3. Australian Commission on Safety and Quality in Health Care. OSSIE guide to clinical handover improvement. Sydney: ACSQHC; 2010.
4. National Academies of Sciences Engineering and Medicine. Improving diagnosis in health care. Washington (DC): Institute of Medicine; 2015.
5. Naylor MD. Transitional care of older adults. Ann Rev Nurs Res 2002;20(1):127–47.
6. Vincent C. Patient safety. 2nd ed. Oxford: Wiley-Blackwell (BMJ Books); 2010.
7. Jorm CM, White S, Kaneen T. Clinical handover: critical communications. Med J Aust 2009;190(11):108–9.
8. Office of Quality and Patient Safety (US). Sentinel event data: root causes by event type 2004–2015. Oakbrook Terrace (IL): The Joint Commission; 2016.
9. NSW Health Care Complaints Commission. Annual report 2015–16. Sydney: HCCC; 2016.
10. Office of the Health Services Commissioner. Health Services Commissioner annual report 2016. Melbourne: OHSC; 2016.
11. Office of the Health Ombudsman. Annual report 2015–16. Brisbane: OHO; 2016.