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Safety Focus: Checking & Coaching Safety Behavior: Team Member Checking & Coaching Learn and adopt the safety behavior “Team Member Checking & Coaching” using ARCC (Ask a question, Request a change, Voice a Concern, Invoke Chain of command). By using this simple behavior, we can improve patient safety and move closer to our goal of zero events that harm or hurt our patients. Expectation Personal, Patient & Team Safety Techniques You can practice team member checking and coaching by using the ARCC method: 1. Ask a question. If you notice, for example, that a physician or co-worker forgot to wash his or her hands before entering a patient room, simply ask a question: Did you forget to wash your hands before going into Mrs. Jones’ room? 2. Request a change. If your question is ignored or dismissed, request a change such as: Please take a minute to wash your hands before you enter Mrs. Jones’ room. 3. Voice a Concern. Should your co-worker or a physician ignore your request, voice a concern: I’m concerned that you will put Mrs. Jones at risk for infection by not washing your hands before you enter her room. 4. Invoke Chain of command. While we hope this final step isn’t necessary, it’s vital that each of us commits to invoking the chain of command if we witness an unsafe habit or process. If your concern is ignored, you could say something such as: I need to report this unsafe habit to my supervisor immediately. Other ways to use this safe behavior include asking a co-worker to check your calculations for a complex dosage, ensuring co-workers are wearing personal protective equipment, calling a timeout before a surgical procedure and using appropriate equipment or devices to safely move or transfer a patient. Can you think of additional “checking behaviors” for your department or team? Tips for Leaders Reinforce and build accountability by using these leadership methods: •

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Daily Line-Up – discuss safety in your huddles

A Safety Story When we are doing those routine, frequent skill-based tasks, a cross-check significantly improves our probability of “getting it right.” It’s called the multiplier effect. Here’s how it works: Let’s say I’m doing something very simple – like washing in or washing out with a hand cleanser for infection control when I

enter or exit a patient’s room. When I’m committed to doing this hand hygiene, the probability that I may experience a skill-based lapse and NOT do it is about 1 out of every 1,000 entries. Now if you’re with me and you care about the patient and you care about me enough to watch out for me, your error probability is similarly 1 out of 1,000. So we then multiply those two together and we’re 1 out of a million. So while 1 out of a thousand is not even close to that six sigma-like quality we want, if you care enough to say, “Are you going to wash in?” then suddenly we go to 1 out of a million, which is six sigma-like quality – wow! Point to Emphasize Every organization should have a safe word and at our hospital that word is CONCERNED. Whenever somebody says they’re Concerned, that should set off bells and whistles in our heads causing us to stop and address why this person has this genuine worry that we’re about to harm a patient. 1/12


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