NSQHS Standard 6: Communicating for Safety in Clinical Practice

Communication failures are the leading cause of adverse events in healthcare. Not medication errors. Not surgical mistakes. Communication. The World Health Organization has identified poor communication as a contributing factor in roughly 70% of sentinel events globally. In Australia, the picture is no different. Clinical incident data consistently shows that breakdowns in communication between clinicians, between shifts, and between services sit at the root of preventable harm.

NSQHS Standard 6 exists because of this reality. It is the communicating for safety standard, and it sets out what your organisation must do to ensure critical information reaches the right person, at the right time, in the right format.

If you treat this standard as paperwork, you will fail the audit and, more importantly, you will fail your patients.

What does NSQHS Standard 6 require?

Standard 6 of the National Safety and Quality Health Service Standards is titled "Communicating for Safety." It applies to every health service organisation assessed against the NSQHS Standards.

The standard has five action areas:

Clinical governance and quality improvement to support effective communication
Correct identification and procedure matching
Communication at clinical handover
Communication of critical information
Documentation of information

These are not isolated boxes to tick. They form an interconnected system. Your handover process feeds into your documentation. Your patient identification practices underpin everything else. And your clinical governance framework is the structure that holds it all together.

For a broader overview of all eight NSQHS Standards and how they relate to each other, see our complete NSQHS standards guide.

How does clinical governance support safe communication?

Governance is the foundation. Without it, your communication processes are ad hoc and inconsistent.

Under Standard 6, your organisation must have:

Policies and procedures for clinical communication, including handover, documentation, and critical information transfer
Training programs so your workforce understands and can use the approved communication tools
Monitoring and audit systems to check whether communication processes are actually working
Incident review processes that specifically examine communication failures as contributing factors
Consumer involvement in the design and review of communication systems

The governance piece requires you to treat communication as a clinical safety system, not an afterthought. Your clinical governance committee should be reviewing communication-related incidents, tracking audit results for handover compliance, and acting on the findings.

One thing that separates high-performing organisations from the rest: they don't just have communication policies. They actively monitor whether those policies are followed and they close the loop when gaps appear.

AHCRA's compliance platform includes policy templates and audit tracking tools that help you manage your Standard 6 governance requirements without drowning in spreadsheets.

What are the three approved patient identifiers?

Correct patient identification is a core safety action under Standard 6. Getting it wrong has consequences that range from wrong-patient procedures to medication errors and missed diagnoses.

The standard requires you to use at least three approved identifiers to confirm a patient's identity before providing care. The Australian Commission on Safety and Quality in Health Care (ACSQHC) specifies these approved identifiers:

Patient's full name (as it appears on the medical record)
Date of birth
Medical record number (or other unique identifier such as a healthcare identifier)

You must verify identity at specific points:

Before administering medication
Before collecting specimens or performing diagnostic procedures
Before transferring a patient
Before performing a procedure or treatment
When there is any doubt about the patient's identity

The standard also requires procedure matching. Before any procedure, you must confirm the correct patient, the correct procedure, and the correct site. This applies in surgical settings, but also in clinics performing injections, biopsies, laser treatments, or any invasive procedure.

What is not an approved identifier? Room number, bed number, or diagnosis. These should never be used to identify a patient.

For smaller clinics and day hospitals, the most common failure here is inconsistency. Staff know the regular patients and skip the formal identification steps. Auditors will test this. They will observe your clinical practice, not just read your policy.

How does ISBAR improve clinical handover?

Clinical handover is the transfer of professional responsibility and accountability for a patient's care from one clinician or team to another. It happens at shift changes, during transfers between departments, at discharge, and when referring patients to other services.

Poor handover is where patients fall through the cracks. Information gets lost. Critical details are omitted. The receiving clinician makes decisions based on incomplete data.

The ACSQHC recommends structured communication tools for handover. The most widely adopted in Australia is ISBAR (sometimes written as iSBAR or iSOBAR depending on the variant).

The ISBAR framework

| Component | Stands for | What to communicate | |-----------|-----------|-------------------| | I | Identification | Your name, role, location. Patient's name, DOB, medical record number. | | S | Situation | Why you are communicating. The current clinical issue or concern. | | B | Background | Relevant clinical history. Current medications. Allergies. Recent test results. Relevant social history. | | A | Assessment | Your clinical assessment of the situation. What you think is going on. Vital signs and observations. | | R | Recommendation | What you need from the receiving clinician. What actions are required. Timeframe for follow-up. |

ISBAR works because it imposes structure on what would otherwise be a free-form conversation. It forces the communicating clinician to organise their thinking before they pick up the phone or walk into the handover room. It also gives the receiving clinician a predictable format, which reduces the chance of critical information being missed.

Tips for effective ISBAR handover

Prepare before you communicate. Gather the relevant information first. Don't wing it.
Write it down. Use a handover sheet or electronic tool. Verbal-only handover is high risk.
Allow questions. Handover is two-way. The receiving clinician should have the opportunity to clarify.
Document it. Record that handover occurred, who was involved, and any outstanding actions.
Practise it. ISBAR is a skill. New staff need training and practice, not just a poster on the wall.

Some organisations use the extended version, iSOBAR, which adds "O" for Observations (vital signs and clinical observations between Background and Assessment). Either version meets the standard's requirements, provided your organisation has selected one and uses it consistently.

What are the documentation requirements under Standard 6?

Documentation is the backbone of clinical communication. If it is not documented, it did not happen. Auditors take this literally.

Standard 6 requires that clinical information is documented in the patient's healthcare record in a way that is:

Accurate and reflects what occurred
Legible (for paper records) or clearly structured (for electronic records)
Timely, recorded at or near the time of the event
Accessible to all clinicians involved in the patient's care
Complete, including clinical assessments, interventions, outcomes, and plans

Your documentation system must also support continuity of care. When a patient moves between clinicians or services, the record should tell the story of their care journey without gaps.

For a detailed look at what Australian regulators expect from clinical documentation, read our guide on nursing documentation requirements. While focused on nursing, the core principles apply across all health professions.

Common documentation failures

Progress notes that describe what was done but not why
Gaps in the record during overnight or weekend periods
Assessments without corresponding care plans
Verbal orders not countersigned within the required timeframe
Copy-paste entries in electronic records that contain outdated or incorrect information
Missing or incomplete allergy documentation

How should critical information be transferred?

Critical information includes anything that could significantly affect a patient's care or safety if it is not communicated promptly. Think:

Critical test results (e.g., significantly abnormal pathology or radiology findings)
Unexpected clinical deterioration
Known allergies and adverse drug reactions
Advance care directives or goals of care decisions
Infection status or isolation requirements
Falls risk or other safety alerts

Standard 6 requires your organisation to have systems for identifying, documenting, and communicating critical information. This includes:

Flagging systems in the patient record (electronic alerts, allergy bands, bedside signage)
Escalation protocols for critical test results, including who to notify and within what timeframe
Standardised alert documentation so critical information is visible and cannot be easily overlooked
Read-back and verify processes for verbal communication of critical information

The critical test result pathway is a frequent audit focus. Your pathology and radiology providers should have agreed protocols for notifying your clinicians of critical results. You need to demonstrate that results are received, acknowledged, acted upon, and documented. A result sitting in an inbox that nobody has opened is a system failure.

What happens at transitions of care?

Transitions of care are high-risk moments. They include:

Admission to your service
Transfer between units, departments, or facilities
Discharge from your service
Referral to another provider

At each transition point, Standard 6 requires a structured transfer of clinical information. The receiving clinician or service must have enough information to safely continue care.

For discharge, this means:

A discharge summary completed and sent to the patient's GP within 48 hours (best practice)
Medication reconciliation, including a current medication list with any changes clearly documented
Clear follow-up instructions for the patient
Communication of any outstanding results or pending investigations
Patient and carer involvement in discharge planning

For transfers between facilities, the standard requires a structured clinical handover using an approved framework (like ISBAR) and a documented transfer summary that travels with the patient.

The patient's role in transitions of care is also important. Standard 6 expects your organisation to involve patients and their carers in communication about their care. That means providing information in a format they can understand, checking their comprehension, and encouraging them to speak up if something does not seem right.

How do digital systems affect clinical communication?

Most Australian health services now use some form of electronic medical record (EMR) or practice management software. Digital systems can improve clinical communication, but they also introduce new risks.

Benefits:

Legibility is no longer an issue
Information is accessible from multiple locations simultaneously
Alerts and flags can be automated
Audit trails are built in

Risks:

Alert fatigue from excessive notifications
Copy-paste errors carrying forward outdated or inaccurate information
System downtime disrupting access to critical information
Interoperability gaps between different systems (e.g., hospital EMR vs GP software vs pathology provider)
Clinicians relying on the system and not reading the information thoroughly

Your digital communication systems need the same governance as your paper-based ones. That means policies for system use, training for staff, regular review of alert settings, and contingency plans for system outages.

If you are running a clinic and still managing compliance across disconnected tools, it is worth looking at a centralised platform that keeps your policies, training records, and compliance tracking in one place.

What do auditors look for in a Standard 6 assessment?

Auditors assess Standard 6 through a combination of document review, staff interviews, patient interviews, and direct observation of clinical practice.

Here is what they are checking:

Governance and systems:

Current policies for handover, documentation, patient identification, and critical information transfer
Evidence that policies are reviewed, updated, and communicated to staff
Training records showing staff have been educated on communication tools (e.g., ISBAR)
Incident data related to communication failures and evidence of actions taken in response

Patient identification:

Direct observation of staff checking three identifiers before care
Correct procedure matching for invasive procedures
Patient identification processes in place for patients who cannot identify themselves

Clinical handover:

Observation of handover using a structured tool
Documentation of handover, including outstanding actions
Staff ability to describe the handover process and tool used

Documentation:

Review of patient records for completeness, accuracy, and timeliness
Evidence that critical information (allergies, alerts, advance care directives) is flagged and accessible
Progress notes that reflect clinical reasoning, not just tasks completed

Critical information:

Protocols for critical test result notification
Evidence that critical results are received, acknowledged, and acted upon
Flagging systems in the patient record

Patient and carer involvement:

Evidence that patients are involved in communication about their care
Discharge information provided in an understandable format
Processes for patients with communication barriers (e.g., interpreter services, plain language resources)

What are the most common non-conformities?

Based on published assessment data and common themes from ACSQHC reports, the most frequent Standard 6 non-conformities include:

Inconsistent patient identification. Staff skipping the three-identifier check, particularly for known patients. Auditors will observe this in practice, not just check your policy.
Unstructured handover. Handover happening, but not using a consistent framework. Different staff using different approaches. No documentation of what was communicated.
Incomplete documentation. Progress notes with gaps. Assessments without care plans. Allergy fields left blank or marked "unknown" without follow-up.
Critical test results not actioned. Results received but not acknowledged in the record. No documented evidence that the clinician reviewed the result and took appropriate action.
Discharge communication failures. Discharge summaries not sent to GPs, or sent without a current medication list. Patients discharged without clear follow-up instructions.
No evidence of consumer involvement. No documentation that patients were informed about their care, involved in decisions, or provided with information they could understand.
Training gaps. Staff unable to describe the organisation's communication tools or processes when interviewed by auditors.

If any of these sound familiar, it is time to review your systems. AHCRA offers compliance courses that cover NSQHS Standards including communication requirements, designed specifically for Australian healthcare teams.

Frequently asked questions

Is ISBAR mandatory under the NSQHS Standards?

ISBAR is not mandated by name. Standard 6 requires the use of structured clinical communication tools for handover. ISBAR is the most widely adopted framework in Australia and is recommended by the ACSQHC. Your organisation can use a different structured tool (such as iSOBAR or SHARED), provided it is consistently applied, documented in policy, and staff are trained in its use.

How often should we audit our clinical handover processes?

The standard does not specify a frequency. Best practice is to audit handover compliance at least twice a year, with more frequent audits if you have identified gaps or introduced changes to your handover processes. Your clinical governance committee should set the audit schedule based on risk.

Do allied health practitioners need to follow ISBAR?

Yes. Standard 6 applies to all clinicians involved in patient care, including allied health professionals. If you are handing over clinical responsibility for a patient, whether as a physiotherapist, occupational therapist, dietitian, or any other practitioner, you must use a structured communication tool.

What should we do if our EMR does not support clinical alerts?

If your electronic system does not support flagging critical information (allergies, adverse reactions, advance care directives), you need a workaround. This could include standardised paper-based alert systems, visual cues on the patient record, or manual flagging processes. Document your workaround in policy and ensure all staff are trained. Then have a conversation with your EMR vendor about future functionality.

How do we involve patients who have communication barriers?

Standard 6 expects your organisation to address communication barriers. This includes access to interpreter services for patients who speak languages other than English, use of plain language and pictorial resources, involvement of carers or support persons, and consideration of health literacy levels. Document the strategies you use for individual patients and how you assess their understanding.

Strengthen your communication systems with AHCRA

Communication failures are preventable. The systems, tools, and governance structures described in Standard 6 exist to catch the gaps before they become incidents.

If you are preparing for accreditation, responding to audit findings, or simply want to tighten your clinical communication processes, AHCRA can help. Our platform provides policy templates, compliance tracking, and audit-ready documentation for all eight NSQHS Standards.

Explore the AHCRA platform or get in touch to see how we can support your team.

Sources

Australian Commission on Safety and Quality in Health Care. Communicating for Safety Standard. ACSQHC, 2021.
Australian Commission on Safety and Quality in Health Care. NSQHS Standards (2nd edition). ACSQHC, 2021.
World Health Organization. Patient Safety. WHO, 2023.
Australian Commission on Safety and Quality in Health Care. Clinical Handover Standard. ACSQHC.
Australian Commission on Safety and Quality in Health Care. Patient Identification. ACSQHC.