Magazine article American Nurse Today

Safeguarding Patients: The Courageous Communication Solution: How to Confront Colleagues about Your Safety Concerns

Magazine article American Nurse Today

Safeguarding Patients: The Courageous Communication Solution: How to Confront Colleagues about Your Safety Concerns

Article excerpt

PREVENTABLE MEDICAL ERRORS account for 440,000 deaths each year and are the third leading cause of death in the United States. According to The Joint Commission, communication failure is the third most commonly identified root cause of all sentinel events. A 2005 study titled "Silence Kills: The Seven Crucial Conversations in Healthcare" reported that more than half of 1,700 nurses, physicians, clinical care staff, and administrators witnessed coworkers "break rules, make mistakes, fail to support others, demonstrate incompetence, show poor teamwork, act disrespectfully, or micromanage." Yet, the study states, "despite the risks to patients, less than 10% of physicians, nurses, and other clinical staff directly confronted their colleagues about their concerns."

Building skills for courageous conversations

So how do you get a colleague's attention when you have a safety concern? The Department of Defense partnered with the Agency for Healthcare Research and Quality (AHRQ) to develop a teamwork and communication system to improve safe healthcare delivery. Called TeamSTEPPS, this evidence-based framework optimizes team performance across the healthcare delivery system.

One TeamSTEPPS tool, called CUS, serves as an effective verbal alarm, empowering healthcare providers to "stop the line." When you speak the signal words of the CUS tool--Concern, Uncomfortable, Safety--you alert team members and cue them to clearly understand not just the issue but also its magnitude or severity.

Here are the CUS steps:

1: State your Concern.

2: State why you are Uncomfortable.

3: State that this is a Safety issue. Identify why it's a safety issue and state what actions you think should be taken.

CUS in action

Billy Evans, age 4, has a history of Type 1 diabetes. After an episode of uncontrolled blood glucose, he's admitted to the pediatrics unit. Later, although his blood glucose level has nearly stabilized, his pediatrician wants to delay his discharge until the afternoon, just to be sure his blood glucose remains stable.

At the scheduled time for his insulin injection, his nurse Joanne prepares his injection. Her coworker, nurse Bonnie, approaches her, stating, "Joanne, the amount of fluid in that syringe looks quite large for Billy's insulin dose. How much insulin are you preparing to give him?" Joanne replies,"10 units." Bonnie uses the CUS tool to express her concern.

Bonnie: "I'm CONCERNED that you may be giving him too much insulin."

Joanne: "Why do you think that?"

Bonnie: "It's not uncommon to give adults with diabetes 10 units or more--but Billy's a child and much smaller than an adult. What's his blood glucose level now? I'm UNCOMEORTABLE because 10 units could cause severe hypoglycemia."

Joanne: "I have to hurry and get this done."

Bonnie: "This is a SAEETY issue. I really need you to stop what you're doing and double-check the order."

Joanne puts down the syringe, goes to the computer, and pulls up Billy's chart while Bonnie doublechecks the insulin vial. They both want what's best for Billy.

Caring Feedback Model

To improve both patient safety and satisfaction, staff at every level of a healthcare organization should hold each other accountable to high standards of care. In addition to the CUS method, you can use the Caring Feedback Model to give colleagues feedback about their actions (or inactions) that have safety consequences. Using this model helps people hear your feedback with less defensiveness, because they hear your caring coming through. (See How to use the Caring Feedback Model.)

CUS and the Caring Feedback Model in action

Joe Wilson, age 41, has a history of hypertension. After a recent myocardial infarction (MI), he comes to the cardiology clinic for follow-up care. An electrocardiogram (ECG) shows no evidence of changes, although his blood pressure is a little high. …

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