November safety behavior: ‘Speak up by using ARCC’

An effective way to speak up for safety during November is to use the ARCC communication technique, which stands for ask, request, concern and chain of command.

If something doesn’t seem right:

• First, Ask a question. “Can I ask you a question?”
• If that doesn’t work, Request a change. “Can we try….”
• Still no response? Voice a Concern. “Here is my concern.”
• If that’s not successful, escalate up your leadership Chain of Command. Reach out to your manager.

“ARCC gives us a measured technique to express a concern about patient safety in a nonthreatening way,” said Becky Pomrenke, M.S.N., RN, CNL, CNS, patient safety manager for USA Health. “It starts with a simple question but also provides a way to escalate the issue if it’s not resolved.”

Consider this scenario:

A: A nurse asks a resident why a patient is scheduled for a device removal. The resident replies that the device is infected.

R: The nurse requests a recheck of the cultures related to the device, noticing that the results are negative. The resident states that the recheck is unnecessary, that the device is the only possible site for infection.

C: The nurse states, “I have a concern. The wound culture from this patient came back positive, while the device culture is negative. The infection is from the wound.” The resident restates that the device is the problem.

C: The nurse escalates to an attending physician and states her concerns. The removal procedure is cancelled, and the patient is started on antibiotics.

The safety behavior of the month, part of USA Health’s Safety Starts With Me initiative is discussed and practiced at huddles and in departments across the health system.