Communication is SO important in the resus room. Making sure that your message is heard and understood is really important. There are many aspects to great communication but one of the most important ones is the concept of graded assertiveness.
Graded assertiveness is a way of using specific forms of language and words to raise concerns. Two ways of doing this are shown here, I quite like the second as it’s easier to incorporate the actual words. Use these when you see something of concern that needs to be brought to another person (or team’s) attention. Examples are below.
Match your language to the urgency. You do not need to work through every step: if harm is imminent, use a clear instruction to stop immediately.
PACE prompts
- Probe: Have we checked the concentration in that syringe?
- Alert: The concentration on that syringe looks different from the one we agreed.
- Concern: I think that could deliver the wrong dose. We need to check it before giving it.
- Emergency: Stop. Do not give that drug. We need to check the concentration and dose now.
CUSS prompts
- Concern: I am concerned that we’ve not checked the RSI drugs properly
- Uncomfortable: I am uncomfortable with the drugs being given without a second checker
- Safety: This IS a SAFETY ISSUE. Stop. We must check the drugs properly.
And remember that you may be the recipient of this language as TTL. If that happens, your response matters as much as the words used to challenge you. Acknowledge the concern, thank the person for speaking up, and make sure it is addressed. You may ultimately continue with the original plan, but explain why. How you respond today will influence whether someone speaks up next time.
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