• Standardised framework of communication for handover adapted by KKH nursing to increase patient safety
  • Survey in the piloted wards found that the nurses were able to convey patient information systematically and precisely
  • Winning poster in the Communications category in the Singapore Healthcare Management 2014

Nursing handover is an integral part of clinical practice, and nurses have the critical responsibility of relaying necessary information to other nurses and doctors.

A team at KKH, comprising representatives from the Nursing and Quality, Safety & Risk Management departments, observed that doctors frequently sought clarification or verification from nurses due to inadequate information during handover.

When doctors are not provided with sufficient information, they may not be able to prioritise their duties optimally or feel the urgency of the patient’s case.

To improve patient safety, the team decided to adopt SBAR, a standardised framework of communication for handover.

According to Ms Lau Gek Muay, Deputy Director of Nursing at KKH and leader of this project, SBAR is the acronym for Situation, Background, Assessment and Recommendation.

“It is a standardised tool for effective communication, used in communicating critical information that requires immediate attention or action."

"It is used during handover of key information about the patient,” she explained.

A pilot study was conducted to gauge the effectiveness of SBAR.

Initially, a scenario-based training was held and the nurses were taught to use the SBAR format as a memory prompt.  This, however, did not prove to be effective in encouraging them to cultivate the habit of using the communication framework.

The team then brainstormed for ways to reinforce the use of SBAR among the nurses.

“Each staff from the pilot wards was given an ID-sized SBAR cue card. This card was also pasted on the telephone at the nursing counter to serve as a reminder.  In addition, SBAR posters were placed on the pneumatic tube door cupboards in the wards.  Regular reinforcement during roll call was also done,” said Ms Lau.

After this implementation, a survey in the piloted wards found that the nurses were able to convey patient information systematically and precisely.

79 per cent of the doctors were aware that the nurses were using SBAR, and 66 per cent of the nurses were using it constantly.

The SBAR was subsequently adopted as a communication tool during shift handovers and referrals across all wards in KKH.

“Nursing handover using SBAR ensures that handover is precise and patient care is not compromised.  Clinicians agree that using the SBAR has helped to organise their thoughts and keep their communication process focused,” said Ms Lau.

The team behind this project consists of Ms Annelle Camet, Ms Ho Wah Pong, Ms Luisa Rico Cruz, Ms Ana Lielane, Ms Li Wei Xiao and Ms Lau Gek Muay.

Improving Clinical Handover through Effective Communication for Patient’s Safety was a winning poster in the Communications category at the 2014 Singapore Healthcare Management.

The Singapore Healthcare Management is the premier congress for healthcare administrators, with thought leaders from the areas of healthcare management, supply chain management and enterprise risk management sharing their insights and best practices.