Introduction  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 further investigation.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 understanding.Recommendation 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 know 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.Conclusion 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 skills. 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.


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