Repeating information can save a life
The HRO Tool of the Month comes from the Reliability Skill: Communicate Clearly
At Michigan Medicine, we are committed to a culture of safety and reliability. With that, we must operate at the highest level of clarity in order to prevent harm. This includes active listening, repeating back information and practicing situational awareness.
In this month’s high reliability tool, we will explore how the tool Three-Way Repeat-Back and Read Back is essential to situational awareness and can help reinforce our safety promise.
Looking at Three-Way Read-Back and Repeat Back
Complete and accurate communication is a practice that ensures we understand the patient we are asked to care for and/or the task we are asked to do. This understanding is called situational awareness. Clear communication is key and understanding gives context to the choices we make. So, a poor understanding leads to poor choices — garbage in, garbage out.
We repeat back important information, especially orders, test results and delegated tasks, to ensure that we heard correctly, and exactly what was said. Repeat-back is all oral communication and can be used over a wide range of communications. It includes documenting the information and reading what was documented. It is required by policy for telephone orders, verbal orders and critical tests/values.
A Three-way Repeat-back example:
- Jane initiates communication, “Steve, take this sample to the lab, stat.”
- Steve acknowledges with “I understand” and repeats the message back verbatim, “Take this sample to the lab, stat.”
- Jane acknowledges with “that’s correct” or “that is not correct” and starts the communication again: “That’s correct.”
How should we use this tool?
Use repeat-back for oral communications where precise detail must be communicated as well as meaning. The correct response for sender acknowledgement is “that’s correct.” Do not say “right” because this can be interpreted as a laterality (ie. direction) instead of an acknowledgement.
Important tip to remember:
- Repeat-backs ensure authenticity of communication — you heard it the way I said it.
Here are examples of how to use Repeat Back with coworkers in a clinical and non-clinical setting:
Nurse: Dr. John, I’m calling to confirm that Brian Smith’s heart rate is 80 beats per minute.
Physician: Brian Smith’s heart rate is 80 beats per minute?
Nurse: That is correct.
Associate: Ashley, we will need 750 copies of the oncology newsletter printed and delivered to Radiation Oncology by this Monday, Oct. 7 at 7 p.m.
Designer: Ok. You will need 750 copies of the oncology newsletter printed and delivered to Radiation Oncology by Monday, Oct. 7 at 7 p.m.?
Associate: That is correct.
At Michigan Medicine, you should know that it is OK for anyone to ask a question. If you are unsure, or you just want to be sure, ask. Everyone is encouraged to adapt this way of thinking in order to support each other and move the organization forward.
So when do you need to ask clarifying questions?
- When in high-risk situations
- When information is incomplete
- When information is ambiguous
- When you are unsure
Good thinking starts with a questioning attitude. Ask the question in a polite, professional and helpful way. If asking a question of someone in a higher position, consider using the tool for Speak-Up for Safety.
Did you know?
1. Situational Awareness is a critical thinking skill that gives us the ability to anticipate future problems and notice existing problems.
2. Good communications are the best way to maintain situational awareness among team members and between units. The word communication comes from the word commune — to be as one, as in “one in thought.”
3. 31% of key activities leading to serious patient harm at Michigan Medicine were communication-related.