Components of a Stop-the-Line Assertive Statement

(1)

(2)

1

Components of a Stop-the-Line Assertive Statement

•

Get Attention

-

Call the person by name

•

Express Concern

- Use an “I statement

•  “I need clarity…”

•  “I am concerned . . . .”

•

State the Problem

-

Brief, clear, objective

•  State in 10 seconds or less for immediate attention

•  Don’t “Hint & Hope”

•

Propose a Solution -

“We or Let’s . . .”

•  Don’t ask a Yes/No question!

•  Use of “we” or “let’s” indicates it’s a team problem.

•  If you don’t know the solution, restate the problem, using team words

•  Within scope of your clinical role

(3)

2

Example: Situation # 1

The CRNA, Sally, brought a patient to PACU and began giving a

verbal report before the PACU RN could place the patient on the

monitor. When the RN informed Sally that she should wait until the

RN was ready for the report, Sally kept talking.

Draft an Assertive Statement from the PACU RN to Sally:

Get Attention

Express Concern State the problem Propose Solution

(4)

3

Example:

Potential Statement - #1

Sally, I

’

m concerned that I will miss

important information while I am

focusing on getting the patient

monitored. Let

’

s do report in just a

minute

.

(5)

4

Situation # 2

The tech and the RN are setting up for the case, but the vendor has

not yet arrived with the implant. The anesthesia provider, Dr. Rush,

is in a hurry to start the case, so he brings the patient to the room.

Dr. Rush wants to proceed with induction to avoid further delay.

Draft an Assertive Statement from the RN and/or Tech to Dr. Rush:

Get Attention

(6)

5

Situation # 3

When the circulating RN pulls back the sheet to prep the patient,

she discovers that the clip prep done by Mary, the holding area RN

is incomplete and poorly done. This is not the first time this has

happened.

Draft an Assertive Statement from the Circulating RN to Mary:

Get Attention

(7)

6

Situation # 4

Your co-worker, Steve, does not change gloves between taking off

an old dressing and applying the new one to the patient

’

s wound.

You hand Steve a new set of gloves – he takes them, but glares at

you and refuses to speak to you later.

Draft an Assertive Statement to Steve:

Get Attention

(8)

7

Situation # 5

A patient is crying, clearly upset and uncomfortable. The patient

’

s

caregiver, Queen Bee, is talking and laughing on the phone, clearly

on a personal call, and you believe she is ignoring the patient.

Draft an Assertive Statement to Queen:

Get Attention

(9)

8

Situation # 6

You are relieving another RN, Anita Break, for lunch in the middle of

a procedure. There are specimens on the field that have not yet

been identified or labeled. Anita gives report, states she is

“

very

hungry

”

and that you should be able to handle the specimens.

Draft an Assertive Statement to Anita:

Get Attention

(10)

9

Situation # 7

The patient was brought into the room and positioned by team

members. At the last minute, you are asked to substitute for one of

the members. Finishing your current task takes a few minutes, so

the team proceeds with the Time Out without you – and they do not

want to repeat it when you finally arrive in the room.

Draft an Assertive Statement to your team:

Get Attention

(11)

10

Situation # 8

The RN is preparing the label for the specimen. When the

physician, Dr. Sar Castic, is asked what to call the specimen, he

answers,

“

Call it Fred

”

.

Draft an Assertive Statement to Dr. Castic:

Get Attention

(12)

11

Situation # 9

The policy states that 2 staff members are to be in the treatment

area at all times during setup and patient treatment. This morning,

due to a sick call, one staff member, Ima Loner, is working alone.

You walk by and observe Ima treating patients, she states

“

to avoid

any delays

”

.

Draft an Assertive Statement to Ima:

Get Attention

(13)

12

Situation # 10

The procedure requires that a vendor be present to support the

equipment. During the Time Out, the vendor, Mike, takes a call on

his cell phone. Because the connection is bad, the vendor is

speaking somewhat loudly.

Draft an Assertive Statement to Mike:

Get Attention

(14)

13

Situation # 11

Anesthesia for the patient will be provided by a CRNA student,

monitored by the CRNA, Joe. During the Time Out checklist, the

student is participating, but Joe is having a personal conversation on

his phone. When prompted to hang up and join the team, Joe

replies that

“

she is the provider of record

”

, referring to the student.

Draft an Assertive Statement to Joe:

Get Attention

(15)

14

Situation # 12

The physician, Dr. Imalittle Young, follows the format for the

PreProcedure Briefing, but neglects to make the Safety Statement.

When prompted by the RN, Dr. Young states,

“

If anybody knows of

anything that sucks more than me having to do this, please speak

up.

”

Draft an Assertive Statement from any team member to Dr. Young:

Get Attention

(16)

15

Situation # 13

This case has generated several specimens, with different

processing, i.e. pathology, microbiology. The physician, Dr. I. M.

Impatient, tells the RN,

“

listen up, because I

’

m only going to say

this once

”

, then proceeds to give a detailed, lengthy description of

the tissue.

Draft an Assertive Statement from the RN to Dr. Impatient:

Get Attention

(17)

16

Situation # 14

You are the tech on the case. During the procedure, the surgeon,

Dr. Goyo, and the assistant converse in Spanish. At first, it appears

to be casual and un-related to the case, but then the surgeon says

something to the RN, and she brings over additional equipment.

You are the only caregiver in the room who does not speak Spanish.

Draft an Assertive Statement to Dr. Goyo:

Get Attention

(18)

17

Situation # 15

During a C-section, the RN and tech discover a lap sponge is

missing. The RN announces this to the team, but gets no response,

and the surgeon, Dr. Good Cutter, and assistant continue to close

the uterus. They are nearly done.

Draft an Assertive Statement from the RN to Dr. Good Cutter:

Get Attention

(19)

18

Situation # 16

Prior to beginning a procedure, the physician, Dr. Ree Sistant, does not

wish to conduct the entire Time Out, since there’s no laterality involved and

it’s a simple procedure (PEG tube insertion). He ultimately does so, but

states “thank goodness we did that, or we would have mistakenly stuck this

tube in the patient’s ear”.

Draft an Assertive Statement from any team member to Dr. Ree Sistant:

Get Attention

(20)

19

Situation # 17

The physician is leading a thorough Time Out with a PreProcedure Briefing. About halfway through, the phone in the room rings, and the RN, Miss Dee

Stracted, walks over and answers the phone

Draft an Assertive Statement from any team member to Nurse Dee Stracted:

Get Attention

(21)

20

Situation # 18

The new work schedule has just been posted. Your co-worker, Mr. Dis Pleased, is unhappy with his assignments, and proceeds to disparage the manager and the schedule in front of patient and families

Draft an Assertive Statement to Mr. Dis Pleased:

Get Attention

(22)

21

Situation # 19

The PACU RN notes a developing hematoma after a carotid procedure, and

informs the physician, Dr. Ima Grouch. Dr. Grouch states “why are you

calling me? The Nurses at their other hospitals never call me for this. I’m

not coming there now.”

Draft an Assertive Statement from the RN to Dr. Grouch:

Get Attention

(23)

22

Situation # 20

The team has been called in for an emergency procedure at 4 a.m. No one

thinks it’s necessary to do the PreProcedure Briefing and Time out, except

for you.

Draft an Assertive Statement to your team:

Get Attention

(24)

23

Situation # 21

Once the procedure is complete, a lively discussion erupts around a piece of equipment that was not readily available nor properly prepared. The tech, Dee Fense, gets very upset and begins to blame other team

members for the oversight, including several people who are not in the room.

Draft an Assertive Statement to Dee Fense to help get the discussion back on track:

Get Attention

(25)

24

Situation # 22

You are assuming care from your Co-worker, Miss Short Cutz, who is going on a break. The patient does not have an ID bracelet on, although there is one taped to the chart. Miss Cutz states that the patient came from the nursing unit that way, and will not leave the bracelet on. Miss Cutz asks

you to proceed with the patient’s care, and she will fix the bracelet later.

Draft an Assertive Statement to Miss Short Cutz: Get Attention

(26)

25

Situation # 23

On receiving the patient from the nursing unit, you discover that the Blood Bank has not processed the Type and Screen order because the verbal

order was written with the unapproved abbreviation “u”. The patient’s skin

is broken down at the potential procedure site. When questioned, the

nursing unit RN, Miss Ina Hurry admits she was “rushed” and didn’t

adequately assess the chart or the patient, but “isn’t that your job?”

Draft an Assertive Statement to Miss Ina Hurry: Get Attention

(27)

26

Situation # 24

The patient has undergone MAC anesthesia for an uneventful procedure. After the procedure, the physician, Dr. Wo Isme, begins to complain about the CRM process, multiple delays and the competency of the staff. The RN is concerned that the patient may overhear the comments, even though the patient is sedated.

Draft an Assertive Statement from the RN to Dr. Wo Isme:

Get Attention

(28)

27

Situation # 25

A patient from ICU is brought over for a procedure. The ICU RN, Miss Diz Respect accompanies the patient, but states she is not comfortable in the

procedure room, and states she should “not have to be here anyway, if the

procedure RN’s were any good.” She then proceeds to sit in the control

room and read a nursing journal so as “not to waste my time”.

Draft an Assertive Statement from the procedure RN to Nurse Diz Respect:

Get Attention

(29)

28

Situation # 26

The CRNA has given the PACU RN a post-procedure report. You, the procedure RN, try to give the PACU RN, Mr. I. Gotit, some additional

information not covered in the CRNA’s report. He cuts you off and says,

“CRNA already gave me report – I’m good.”

Draft an Assertive Statement to Nurse I. Gotit:

Get Attention

(30)

29

Situation # 27

“Use SCIPS protocol” is checked off on the preoperative order sheet, but

there is no protocol for the ordered procedure (Port insertion). When you

ask the doctor, Dr. Risky, what antibiotic she wishes to order, she replies, “I

told you not to ask me that for these cases. Don’t ever ask me that again.”

Draft an Assertive Statement to Dr. Risky:

Get Attention

(31)

30

Situation #28

When called by Preop area to give report on her patient, Newbie, the med-surg RN stated that she had no orders for med-surgery. The Preop RN insisted she send the patient – the surgeon, Dr. Rush, later called and insisted she send the patient, then put the Holding Area RN, Miss Ino Better, on the phone.

Draft an assertive statement from Newbie to Ino:

Get Attention

(32)

31

Situation #29

An interventional room is undergoing construction, so the physician decides to perform a case in the OR, despite having been asked not to by the

charge RN, due to staffing/equipment availability. The doctor, Dr. Norules, tells the RN, Suzie, to take the patient to the OR, and the rest of the team can “catch up”.

Draft an assertive statement from Suzie to Dr. Norules:

Get Attention

(33)

32

Situation #30

Dr. Bull began to remove a patient’s dressing in preparation for a catheter

removal. He was not using gloves, had not yet obtained consent, and the patient was still on a stretcher outside the procedure area. Mary, the RN noticed the activity and stepped over to intervene.

Draft an assertive statement from Mary to Dr. Bull

Get Attention

(34)

33

Situation #31

The CRNA, Kahn Fuzed, noticed there was an extra bag hanging on the IV pole that wasn’t needed, and shouldn’t be administered IV. But Kahn knows the other staff member, Benear Longtime, is one of the most experienced in the department and is unsure if he should speak up and sa something.

Draft an assertive statement from Kahn to Benear Longtime:

Get Attention

(35)

34

Assertive Statements

Remember!

The greatest predictor of clinical excellence

is the willingness to speak up you perceive

a problem with patient care.

Speak Up!

(36)

35

Dr. Rush, I

’

m concerned that we may

not have all the needed supplies. Let

’

s

wait to anesthetize the patient until we

have confirmed the implant is here.

(37)

36

Mary, I

’

m concerned that the clip preps

are incomplete and may predispose the

patient to infection. Let

’

s talk about the

type of prep needed for this procedure.

(38)

37

Steve, I’m concerned that not changing gloves as

needed may predispose the patient to infection.

Let’s talk about our dressing change process.

OR

Steve, I’m concerned. I believe you are upset with

me, and we need to be able to work together for safety’s sake. Let’s talk about this.

(39)

38

Potential Statement - #5

Queen, I

’

m concerned. Your patient is

upset and needs some attention.

Let

’

s see what we can do for her.

(40)

39

Anita, I

’

m concerned that there

’

s a

big potential for error here. Let

’

s

label and verify the specimens

together before you go.

(41)

40

Team, I

’

m concerned that I may not have

all the information I need to help keep the

patient safe. Let

’

s repeat the

PreProcedure Briefing so that we are all

on the same page.

(42)

41

Dr. Castic, I

’

m concerned I do not have the

information to accurately label your patient

’

s

specimen. Let

’

s repeat the information for

safety.

OR

Dr. Castic, I

’

m concerned that those comments

detract from our teamwork. Let

’

s work together

to keep your patient safe.

(43)

42

Ima, I

’

m concerned that you are

working alone without our required

cross-checks. Let

’

s talk to the

supervisor about this situation before

anyone else is treated.

(44)

43

Mike, I

’

m concerned that your phone call is

distracting us from our PreProcedure

Briefing and Time Out and that you will not

hear important information. Please hang

up and let

’

s all focus on the discussion.

(45)

44

Joe, I

’

m concerned that the

conversation is distracting, and everyone

in the room needs to participate in the

Briefing. Let

’

s stop our other activities

and focus on the discussion about the

patient.

(46)

45

Dr. Young, I

’

m concerned that those

comments detract from positive teamwork.

Let

’

s all work together to focus on

providing safe care to our patient.

(47)

46

Dr. Impatient, I’m concerned that I don’t have the

necessary information to safely label the specimens.

Let’s verify the information.

OR

Dr. Impatient, I’m concerned that those comments

detract from teamwork. Let’s work together to

focus on caring safely for our patient.

(48)

47

Potential Statement - #14

Dr. Goyo, I

’

m concerned that I will

not respond to your needs during

the case. Let

’

s all communicate in

English for safety

’

s sake.

(49)

48

DELTA! Dr. Cutter, I

’

m concerned.

I

’

m missing a lap sponge. Let

’

s stop

closing and look for the sponge.

(50)

49

Potential Statement - #16

Dr. Sistant, I

’

comment detracts from effective

teamwork. Let

’

s focus on positive

comments that help us work together to

keep the patient safe.

(51)

50

Dee, I

’

m concerned. Answering the phone

now interrupts the briefing and our teamwork.

Let

’

s ignore the phone for now and focus on

the Briefing for our patient.

(52)

51

Dis, I

’

m concerned that your

comments may send the wrong

message to our patients and families.

Let

’

s take this discussion to a private

area.

(53)

52

Dr. Grouch, I’m concerned that this hematoma may

compromise your patient’s airway. Let’s discuss our

plan of action.

OR

Dr. Grouch, I’m concerned that those comments detract

from teamwork. Let’s focus on what we need to do to

keep your patient safe.

(54)

53

Potential Statement - #20

Team, I

’

m concerned that not doing

the Preprocedure Briefing will

compromise our patient

’

s safety.

Let

’

s do the right thing.

(55)

54

Miss Fense, I

’

m concerned. The

goal of our comments is to focus on

what we can do better as a team, not

to point fingers. Let

’

s keep the focus

on performance.

(56)

55

Short Cutz, I

’

m concerned. Not

having a bracelet seriously

compromises our ability to provide

safe care. Let

’

s fix the bracelet

now.

(57)

56

Ina, I

’

m concerned. These are major

safety issues for the procedure. We need

to work together to ensure the patient

’

s

safety. Let

’

s talk about the steps needed

for pre-procedure preparation.

(58)

57

Dr. Isme, I

’

m concerned that those

comments do not enhance teamwork, and

that the patient may overhear them. We

can address your concerns outside the

room.

(59)

58

Miss Respect, I

’

m concerned that we are

not working together to safely care for the

patient. Let

’

s help you get situated in the

room and work together to get the patient

safely through the procedure.

(60)

59

Potential Statement - #26

I. Gotit, I

’

m concerned that you will

not have all the information you need

to take care of the patient. Let

’

s

review the additional information.

(61)

60

Dr. Risky, I

’

orders for antibiotics are not clear.

Let

’

s clarify the orders so that your

patient gets what she needs.

(62)

61

Ino, I

’

m concerned that we do not have

the right patient. There are no orders for

surgery, and the patient has eaten. Let

’

s

verify using patient name and MR #.

(63)

62

Potential Statement - #29

Dr. Norules, I’m concerned that we will not have

the things we need to safely care for the patient.

Let’s discuss this further and get everything into

place.

(64)

63

Dr. Bull, I’m concerned that we may not have what

you need in this location. Let’s get the patient into

the room, get our consent, and get the supplies to do this safely.

(65)

64

Potential Statement - #31

Benear, I need some clarity about this extra bag on the IV pole. It looks like it is not needed and it is something that shouldn’t be administered by IV.

Let’s double check to make sure this is set up

correctly so we don’t have a medication mistake.

(66)

Certification

I certify that _________ _ , _

Has demonstrated today the ability to make a Stop-the-Line Assertive

Statement.

_______________________

__________ ___ __________, ___________

___________

www.SaferPatients.com LifeWings Partners LLC 65

(First Name) (M.I.) (Last Name) (Designation)

(Your Signature)

(Your First Name) (M.I.) (Your Last Name) (Designation)

Components of a Stop-the-Line Assertive Statement