The SafeLee Safety Tools Handbook

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Table of Contents

Introduction from K. Alex Daneshmand, D.O., MBA
Chief Quality and Patient Safety Officer........................................ Page 3
Lee Health Mission, Vision and Values............................................ Page 4
Red Rule............................................................................................... Page 5
STAR..................................................................................................... Page 6
Phonetic and Numeric Clarification................................................ Page 7
Clarifying Questions.......................................................................... Page 8
Question and Confirm........................................................................ Page 9
CUS..................................................................................................... Page 10
Stop the Line.......................................................................................Page 11
Three-Way Repeat Back...................................................................Page 12
SBAR...................................................................................................Page 13
Cross-Monitoring...............................................................................Page 14

Patient Safety Handbook 2 Lee Health

Patient safety:
Why it matters.

TEAM,
Safety is a fundamental priority of our health system. We have a responsibility to
each other and to our patients to create an environment of healing that keeps patients
safe and does not cause harm.

Every person in the health system is responsible for driving this culture and is
empowered to speak up when they see a safety issue.

This guide provides the tools to help us avoid errors and keep our patients safe.

As we discuss Lee Health’s approach to safety, quality and experience, it’s also
essential to reflect on how our performance affects patients. You may be familiar with
this patient credo from the Institute for Healthcare Improvement – “Don’t hurt me, heal
me. Be nice to me.” That is the essence of what our patients are asking of us.

In addition to using the tools in this guide, we must constantly view our care from
the patient’s perspective. Empathy, compassion and respect will help us truly keep
patients at the center of all we do.

Thank you for your dedication to Lee Health and the safety of our patients.
Sincerely,

K. Alex Daneshmand, D.O., MBA
Chief Quality and Patient Safety Officer.

Patient Safety Handbook 3 Lee Health

Mission Vision Values
Why We Exist Our Aspiration
The Essence of
Who We Are

Mission Vision

To be a trusted partner, To inspire hope, and be a national
empowering healthier lives leader for the advancement of
through care and compassion health and healing

Values Compassion
We care for your family like our own.
Respect We truly embody, “caring people,
We respect you, your life and your inspiring health.”
healthcare choices. We respect one another
as colleagues, caregivers and people. Education
We support education as a means to
Excellence continuously improve ourselves and to
We strive for excellence in everything we empower healthier lifestyles throughout
do. We uphold the highest standards of our community.
safety and quality, deliver an exceptional
experience to our patients and manage our
resources responsibly.

Patient Safety Handbook 4 Lee Health

Red Rule:
Remember... It Takes Two!

Proper patient identification is one of the hallmarks
of patient safety and is the only way to reduce errors
related to the misidentification of patients.

A Red Rule is an act that bears the highest level
of direct risk to the patient’s or care team’s safety.
Because it is of such a priority, it is considered “Red”
to signify its importance over other rules.

How to use this tool:

We always match and verify two patient identifiers in every patient interaction to
ensure we provide the right care to the right patient every time.

The most common patient identifiers are:

• Full name

• Date of birth

• Medical Record Number

• Epic Contact
Serial Number (CSN)

Patient Safety Handbook 5 Lee Health

Be a
Safety STAR!

STAR is a simple, four-step technique for preventing skill-based errors. It helps

keep us in the moment and focused on the task at hand.

STAR IS AN ACRONYM FOR: STAR
Stop: Pause for 1-2 seconds to focus

attention on the task at hand.

Think: Visualize the task and what needs to

be done.

Act: Concentrate and perform the task.

Review: Check for the desired result.

How to use this tool:

The best times to use STAR are when you are going from thought to action, such as
administering medication or entering data into a device or computer.

USING STAR MAKES YOU

10 TIMES LESS LIKELY TO MAKE

A SKILLS-BASED ERROR.

Patient Safety Handbook 6 Lee Health

Phonetic and Numeric

Clarification

Hooked on Phonetics

Phonetic and numeric clarification improves comprehension of words that sound alike.
Using phonetic and numeric clarification reduces the likelihood of miscommunicating
important information, like medication dosages, lab values and equipment set points,
among many others.

How to use this tool:

When talking, say the letter and follow it with a word that begins with the letter. It
doesn’t matter whether your “D” is duck, David or delta. What’s important is that you
use a phonetic clarifier.

Make sure also to spell out the number when
relaying important values. For example:
“15 – that’s one-five.”
“425 – that’s four-two-five.”
“0.9 – that’s zero-point-nine.”

Patient Safety Handbook 7 Lee Health

Clarifying Questions
for Understanding

Clarifying questions help us make sure we really
understand what’s being communicated.

It’s better to ask the question than make

a decision or complete a task based on a wrong
assumption.

BY ASKING CLARIFYING QUESTIONS, WE GET A BETTER UNDERSTANDING.

How to use this tool:

Ask your question in a way that will give an answer that improves your understanding
of the information. Use it:

• In high-risk situations.
• When information is incomplete.
• When information is not clear.

Patient Safety Handbook 8 Lee Health

Question and Confirm:
Why Is That?

Critical thinking is an essential part of what we do to keep patients safe
and this requires all of us to have a questioning attitude. This means we’re challenging
existing protocols and activities that could result in an error or other unsafe action.
Without questioning and confirming information, we risk
making wrong assumptions, failing to note something out of
the ordinary, using incorrect information or misinterpreting
correct information.

How to use this tool:

If something doesn’t seem right, it probably isn’t. Ask yourself:

• Does it make sense to me?
• Does it fit with what I know?
• Is it what I expected to see?

To confirm, check with an independent or
expert source, such as policy, reference, medical

record or a colleague.

Patient Safety Handbook 9 Lee Health

Don’t be Afraid to C.U.S.
For Patient Safety

When there is doubt or uncertainty during our work, it’s always better to stop and
regroup than press forward and make an error.
C.U.S. is an essential acronym at Lee Health for how anyone on our team can pause
and elevate any safety issue they see, if necessary. It stands for:

C: Voice Your Concern.

U: State why you are Uncomfortable.

S: If the safety concern is unresolved, Stop and take your concern up

the chain of command.

This error prevention tool helps us reevaluate any situation and elevate concerns, if
necessary, to ensure we’re providing safe care for our patients.

How to use this tool:

• Start by saying, “I’m concerned.”
• If your concern isn’t acknowledged, then say, “I’m uncomfortable.”
• If still nothing is done, proceed by saying, “Stop, I’m concerned

that a safety issue will occur.”
• Then take your concern up the chain of command, from supervisor

to director and on up.

WE SHOULD ALWAYS USE C.U.S.

IN A CALM AND RESPECTFUL VOICE.

Patient Safety Handbook 10 Lee Health

Unsure? Everyone Can
“Stop the Line” for Safety

When faced with uncertainty in our roles, especially in situations that involve the
safety of a patient or team member, it’s always better to pause and clarify than push
ahead, given the high probability of committing an error.

“Stop the Line” is a phrase borrowed from

manufacturing, but the message is the same: Every
employee at Lee Health has the authority to stop
any ongoing action when they believe conditions
are unsafe or could lead to an unsafe act.

This error prevention tool is used to stop and reassess
the situation so that everyone is on the same page before
continuing.

How to use this tool:

Simply state, “I need to stop the line; I need clarity.” Then, pause the activity or
task.

STOPPING THE LINE SHOULD ALWAYS

BE DONE IN A CALM AND RESPECTFUL VOICE.

Patient Safety Handbook 11 Lee Health

Three-Way
Repeat Back

Say That Again

Three-Way Repeat Back is a tool to make sure the receiver hears what you intended to
communicate. With this tool, the receiver writes the information, request or order and
reads it back.

DON’T RELY ON YOUR MEMORY; WRITE IT
WRITE IT DOWN WHENEVER YOU DOWN
RECEIVE CRITICAL INFORMATION
THAT MIGHT BE DIFFICULT TO
REMEMBER.

How to use this tool:

1. The sender initiates communication using the receiver’s
name. The sender provides an order, request or information to the
receiver in a clear, concise format.

2. The receiver acknowledges they received the communication
by a repeat back of the order, request or information.

3. The sender acknowledges the accuracy of the repeat back by
saying, “That’s correct” or “No, that’s not correct.” If not correct,
the sender repeats the communication.

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SBAR:
The Perfect Handoff

SBAR is the acronym for a communications tool we use to standardize
communications handoffs. It stands for:

Situation – Who and what you’re communicating about, the

immediate problem and your concern.

Background – Review pertinent patient information, environment,

procedures and status, etc.

Assessment – Your view of the situation or urgency of action: “I think

the problem is…”, “we need to do something.”

Recommendation – Your suggestion or request to the other person.

Across the continuum of care, there are multiple times you will hand off a patient.
There must be clear handoff communication. SBAR is an excellent way to provide
feedback to a colleague and also identify problems or issues at handoffs.

How to use this tool:

ALWAYS USE SBAR TO

COMMUNICATE AN ISSUE OR
PROBLEM THAT NEEDS RESOLUTION
OR ATTENTION, ESPECIALLY WHEN
COMMUNICATING WITH PHYSICIANS.
MAKE SURE YOU SAY THE SBAR
WORDS AS YOU GO THROUGH THE
PROGRESSION.

Patient Safety Handbook 13 Lee Health

Cross-Monitoring:
Everyone Needs a Wingman

Situation awareness is the process of consciously scanning the
environment to gain information or maintain an accurate understanding of the
conditions that affect one’s work. It enables care team members to identify potential
issues early enough to correct them before they become a problem or pose harm to
others.

Cross-monitoring is “watching each other’s
back” and monitoring the behavior of others to

be sure that procedures
are followed appropriately.
Cross-monitoring is
essential to the care team’s
primary goal: a safe patient
experience.

How to use this tool:

We trust everyone on our team to perform their jobs to the best of their abilities,

but we’re all human. To prevent errors, make sure you constantly
check your work and make yourself available to check a
team member’s work or help if needed. It’s about being supportive or our

colleagues and ensuring we’re all watching each other’s backs.

Patient Safety Handbook 14 Lee Health