Improving Patient Safety in Long-Term Care Facilities

Appendix 2-A. Suggested Slides for Module 2

Slide 1

Knowledge objectives

Participants will understand:

  • Why communicating changes in a resident's condition is an important safety issue.
  • Why communication lapses are a major risk factor for resident safety.
  • Key principles of effective communication.

Slide 2

Knowledge Objectives (continued)

Participants will understand:

  • Typical obstacles to effective communication and how to overcome them.
  • What should be communicated about changes in a resident's condition.
  • How to communicate a resident's change in condition using the SBAR and CUS tools.

Slide 3

Performance Objectives

Participants will be able to:

  • Demonstrate good communication techniques.
  • Practice good communication skills.
  • Effectively communicate a change in a resident's condition.
  • Use some simple tools to improve communication.

Slide 4

Case Study: Mrs. C

  • What needs to be communicated?
  • By and to whom?
  • How?
  • When?
  • Where?
  • How do you know when the communication has worked?

Slide 5

Reporting Changes in a Resident's Condition

  • Detecting and reporting changes: essential to patient care.
  • Reporting changes is necessary for quality resident care.
  • Reporting involves the following skills:
    • Communicating what you have noticed to the care team.
    • Working together to identify what the change might mean.
    • Working with the team to take action to make sure the resident is safe.

Slide 6

A Safe Environment

  • Reporting changes helps keep residents safe.
  • Learning and experience are what make safety possible.
  • Openly reporting anything that might affect a resident's wellbeing is essential for a safe environment.
  • Change in a resident's condition should be reported openly, whenever it happens.

Slide 7

Communicating About Unwanted Events

  • Learn to communicate openly when something happens that might affect a resident's well-being.
  • Move beyond blaming anyone to being able to openly share experiences.
  • Show you care by speaking up.

Slide 8


  • Express yourself in a way that you will be "heard."
  • "Hear" how other people answer you.
  • Two types of communication: verbal and non-verbal.

We all are responsible for communicating about change in a resident's condition.

Slide 9

Stages of Communication

  • Get ready.
  • Give your information.
  • Check to see if it was received.

Slide 10

Stages of Receiving Communication

  • Listening.
  • Responding.
  • Following up.

Slide 11

Barriers to Communication

  • Differences in:
    • Gender.
    • Age/generation.
    • Language.
    • Culture.
    • Status.
  • Interpersonal issues.
  • Environmental or system barriers.
  • Workload issues.

We may face several communication barriers at the same time.

Slide 12

Session 1 Summary

For good communication:

  • Have ideas about how to work around barriers.
  • Give clear messages.
  • Focus your attention by actively listening.
  • Be aware of nonverbal signals, both given and received.
  • Give and ask for feedback.

Slide 13



  • Identify yourself.
  • Identify the resident.
  • State the problem.
  • Give a physical assessment report.
  • Be brief and concise.


  • Brief medical history.
  • Health care already provided.
  • Medications list.
  • Allergies.
  • Vital signs.
  • Lab results.
  • Advance directive or code status.


  • Findings.
  • Severity.
  • Life-threatening?


  • What should happen next?
  • What do you need?
  • Timeframe?

Slide 14

Benefits of SBAR

  • Teamwork.
  • Expectations.
  • Critical thinking skills.
  • Patient safety.

Slide 15

Using the SBAR Tool

  • Speak clearly.
  • Review the chart.
  • Complete the SBAR.
  • Document the SBAR in progress notes.

Slide 16

Example: Nursing Assistant to Nurse


  • Ms C fell asleep in her clothes this evening and cursed at me.


  • She is the 85-year-old from room C6; she is usually pretty friendly and does her own ADLs.


  • She seems okay physically, but I am worried.


  • I'd feel better if you would take a look at her and make an assessment.

Slide 17


  • I am Concerned.
  • I am Uncomfortable.
  • The Safety of the resident is at risk.

Slide 18

Information to Be Communicated

  • Top physical and non-physical changes to watch for in residents.
  • Nursing assistant communication tasks.
  • Licensed nurse communication tasks.

Slide 19

Session 2 Summary

  • Noticing changes in a resident's condition is important, but it is not enough to ensure resident safety and well-being.
  • Changes must be detected early and communicated promptly.
  • A safe environment depends on good communication.
  • Everyone is responsible for speaking up.
  • Communication skills can be learned.
  • We all face barriers to communication.

Slide 20


  • Caring means communicating.
  • Communication happens in many directions, among many disciplines.
  • Communicating effectively = speaking up and listening for feedback.
  • Effective communication involves speaking and listening.
  • Often, there are barriers to communication, and frequently several barriers at the same time.
  • Communication tools like SBAR and CUS help us structure our communications.

Slide 21


  • Assuming that someone in a higher position knows what is happening is often incorrect.
  • Saying something does not mean you have been heard.
  • Assuming that someone from a different culture who speaks your language understands you is often incorrect.
  • Forgetting to listen can be as much of a problem as not speaking up.
Page last reviewed October 2014
Page originally created June 2012
Internet Citation: Appendix 2-A. Suggested Slides for Module 2. Content last reviewed October 2014. Agency for Healthcare Research and Quality, Rockville, MD.
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