Archive for the ‘Best Practices’ Category


Wednesday, November 30th, 2011

Briefs serve the following purposes:

  • They clarify who will be leading the team so that others know to whom to look for guidance
  • They open lines of communication among team members, ensuring that everyone can contribute their unique knowledge base to the task, and thereby set the tone for the upcoming procedure. Protocols, responsibilities, and expected behaviors are discussed and reinforced so that possible misunderstandings are avoided
  • They prepare the team for the flow of the procedure, contingency plans, and the means for resolving any unusual circumstances
  • By delineating expectations, they reduce disruptive or unexpected behaviors

Check Backs

Wednesday, November 30th, 2011

A check-back is a closed-loop communication strategy used to verify and validate information exchanged. The strategy involves the sender initiating a message, the receiver accepting the message and confirming what was communicated, and the sender verifying that the message was received. Typically, information is called out anticipating a response on any order which must be checked


Wednesday, November 30th, 2011

How do you acquire a trained eye as you “monitor the situation” on your unit? What are relevant components of the situation that provide clues about impending complications or contingencies? The STEP process is a mnemonic tool that can help you monitor the situation and the overall environment. The STEP process involves ongoing monitoring of the—

  • Status of the patient
  • Team members
  • Environment
  • Progress toward the goal


Wednesday, November 30th, 2011

An ad hoc meeting to discuss issues, realign resources and modify the plan.

Two Challenge Rule

Wednesday, November 30th, 2011

It is important to voice your concern by advocating and asserting your statement at least twice if the initial assertion is ignored (thus the name, “Two-Challenge rule”). These two attempts may come from the same person or two different team members. The first challenge should be in the form of a question. The second challenge should provide some support for your concern. Remember this is about advocating for the patient. The Two-Challenge tactic ensures that an expressed concern has been heard, understood, and acknowledged (HOOAH!).


Wednesday, November 30th, 2011

Using the CUS technique provides another framework for conflict resolution, advocacy, and mutual support. Signal words, such as “danger,” “warning,” and “caution” are common in the medical arena. They catch the reader’s attention. “CUS” and several other signal phrases have a similar effect in verbal communication. When they are spoken, all team members will understand clearly not only the issue but also the magnitude of the issue.

  • First, state your Concern.
  • Then state why you are Uncomfortable.
  • If the conflict is not resolved, state that there is a Safety issue.