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Empowering staff to speak up - CUS mnemonic

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Hi All, 

I have just discovered this forum and wanted to share a mnemonic that we used at my local hospital in the USA to help those staff members who may be intimidated by the medical or interdisciplinary staff hierachy.

Of course that hierachy culture requires being broken down in any facility but sadly still exist from my experience of working in Patient Safety in the UK.

When telephoning or presenting a patients condition who a nurse is worried about, as well as using initially the standard SBAR tool, conclude the conversation using the mneumonic CUS 

CUS is a communication tool to gives interprofessional team members a constructive approach to openly discuss an identified safety concern

C- Concerned

U- Uncomfortable

S- Safety

Here's an example to the conclusion to the SBAR report:

I am Concerned about Mrs J's observations especially her confusion,low blood pressure, elevevated heart rate and high temperature.

I am Uncomfortable that despite the paracetomol and IV fluids, she has not responded. I have tried to get a medical team member to see her for further assessment

I think this is a Safety issue and she is deteriorating. Please can you come and see her now.

Using those strong words, help to guide a staff member in how to escalate the issue and perks up the ears of the listener!

This website gives other examples (albeit US) they can be adapted.


I've written too many Serious Incidents, as an investigator, where staff did not feel listened to or empowered to speak up, so may be helpful for some of you on the forum, to help empower staff to speak up?

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