SBAR & CUSS to Care: Speaking the Language of Patient Safety

Nurses are on the front lines of patient advocacy. When patients are sick, they're often at their most vulnerable— confused, overwhelmed, or unable to speak for themselves. Nurses help them navigate the healthcare system and ensure their voices are heard. By advocating for safety and quality care, nurses protect and empower those who need it the most.

Communication

Effective communication skills are essential to patient advocacy. In moments of conflict, uncertainty, or concern, how nurses communicate can be instrumental in reaching a resolution and maintaining team cohesion.

For example, a nurse may ask a question out of genuine curiosity or lack of understanding, but the physician may perceive it as challenging their judgment. This misunderstanding can lead to defensiveness or tension. The same dynamic may occur when a senior nurse addresses a newer nurse in a critical tone, unintentionally creating conflict. These scenarios highlight the importance of clear, respectful communication.

Framing questions from a learning perspective and focusing conversations on patient safety—rather than personal critique—can prevent escalation and foster collaboration. Concerned communication should never occur in front of patients or family members, as it can undermine the healthcare team and erode trust. Tools like SBAR, Bedside Report, Huddles, and CUSS support clear communication and promote a culture of safety.

Stop the Error Before It Starts: SBAR Saves Lives

Beginning each shift with a bedside report promotes patient satisfaction, safety, and quality of care. Bedside shift reports (BSR) allow nurses to share vital information directly with the patient, their support person(s) (with permission), and each other. Real-time exchanges during BSR help prevent communication errors between shifts. A brief SBAR summary highlights key updates, including medications, vital signs, patient goals, and care plans. These details ensure everyone is informed and can identify potential concerns early.

Understanding Patient SBAR: Key Information to Share

• Situation: Briefly state the patient's current condition or diagnosis.
  Example: Mr. Jones is a 65y/o diabetic admitted for observation following a syncope episode and c/o chest pain.
• Background: Provide pertinent patient history, including current medications, vital signs, and allergies.
  Example: Mr. Jones's vs overnight were.... his initial EKG showed ST elevation. He is taking the following medications and will be due for you next at ... he is allergic to nuts, and PCN.
• Assessment: Share your clinical assessment, noting any changes or areas of concern.
  Example: Mr. Jones was disoriented on admission; however, he appears to be improving and is Alert and Oriented X4. He continues to complain of chest pain intermittently and only upon exertion. Blood sugar has been .... He is currently tolerating fluids and is voiding QS.
• Recommendations: Suggest interventions or actions to consider for the next shift.
  Example: Repeat EKG and labs are due at 0900, Blood sugar will be due 2 hours post breakfast, and if he continues to improve, they will consider discharge to home tonight or tomorrow with follow-up appointments for cardiology and PCP.

BSR-SBAR communication fosters an open dialogue and patient involvement, improving outcomes and increasing efficiency.

When In Doubt, Speak Out: Using CUSS to Prevent Harm

We can all agree that patient safety is a top priority. Healthcare professionals have a duty to do no harm, but mistakes happen. Sometimes, a physician places an order that a nurse may question or disagree with, such as an IV push of Potassium. Potassium should be given orally or by IV piggyback over 30-60 minutes. Speaking up to prevent harm is one way for the nurse to voice concerns. The CUSS method offers a structured framework for fostering respectful and professional communication among team members.

• Concerned: Express concern or unease about the situation.
  "I'm concerned about this order for Potassium IV push."
• Uncomfortable: Clearly state why the situation makes you uncomfortable.
  "I'm uncomfortable administering potassium this way because it can cause immediate cardiac arrest."
• Safety issue: Articulate how the situation poses a risk to patient safety and requires immediate attention.
  "This is a safety issue. Potassium is administered orally or IV piggyback, never IV push."
• Stop: Cease the action or process until safety concerns are addressed.

The nurse then explains that she is happy to administer potassium to the hypokalemic patient once the order is correct. The physician acknowledges the risk and changes the order to IV piggyback over 1 hour. This example demonstrates how respectful and clear communication using CUSS can prevent a serious medication error and keep the patient safe.

Huddle Up for Safety

Huddles can occur in various formats and multiple times throughout the day. Effective huddles include physicians, nurses, the nurse manager, and ancillary staff, when appropriate. Coordinating bedside and shift huddles helps optimize staff communication among the care team.

Shift huddles should occur at a consistent time each day and include nurses, the nurse manager (when available), physicians, case managers, and social workers. Ideally, the huddle takes place after the shift report, following nursing assessments and physician-to-physician handoffs. Attending physician or resident-led shift huddles provide critical updates, including each patient's diagnosis, key clinical information, and anticipated needs for the shift. Other staff may contribute patient-specific updates or concerns as needed. At the close of the huddle, the physician leader should ask if anyone has questions to prevent miscommunication.

Bedside huddles can take place anytime a clinical need arises, but should occur at least once per shift. These huddles should include the patient, their support person (with the patient's permission), and members of the healthcare team, such as nurses, physicians, and residents. Bedside huddles offer an opportunity to share the care plan and actively involve the patient in decision-making.

In Summary

Strong communication is the foundation of safe, high-quality care. Integrating tools like SBAR, CUSS, bedside reports, and huddles into daily routines allows healthcare professionals to prevent errors, build trust, and advocate effectively for every patient. Speak up, collaborate, and create a culture where safety isn't an afterthought; it's the first step.

How and When to Talk to Your Daughter About Their First Period

Confidence Starts Early: Tips for Having the Period Talk

Empowered parents remove the shame from change and equip the next generation of superwomen. Start the talk early—waiting until their first period is too late. An unprepared daughter may feel fearful, confused, think they're dying, or turn to peers for inaccurate answers.

Most teens' first period starts around age 12-13, though it can happen as early as 8 or as late as 15. Watch for early signs like breast buds, followed by underarm, leg, and pubic hair. They may ask questions about their body, shaving, or deodorant; use those questions to start the conversation.

Keep it simple. Too much information can be overwhelming. Instead, talk during natural moments—when your daughter asks questions about puberty or babies, or when you're shopping for feminine hygiene products.

Normal Menstrual Cycle

Teach your daughter what a period looks like so they feel confident, not afraid. Show them what's normal, what's not, and when to call the doctor. Periods usually last 2-7 days and come every 21-45 days. Flow equals about 3-6 pads or tampons a day. Cycles may stay irregular for months to three years after their first period. Remind them that this is normal and their hormones will balance as they grow. A calendar or period tracker app like Flow helps them track their cycles.

Assure your daughter that they can speak up about their period. They will learn what's normal and if something is off. Tell them to trust their instincts. Explain what abnormal flow looks like. Describe cramps so painful that they may prevent walking, and warning signs like bleeding between periods or long gaps without bleeding. Take them with you to your next gynecologist appointment and encourage questions so they feel confident—not afraid—when they schedule their first appointment.

Pads vs. Tampons

Parents often ask which option suits their daughter best: tampons or pads. The choice comes down to personal preference. Consider your daughter's maturity and activity level. Pads usually offer easier management; however, if they play sports or want to swim, tampons may work better.

Adult-size pads won't fit your daughter properly. Amazon sells Red Drop Tween period kits with day and night pads, hygiene wipes, a hall pass card for school, and a small bag for their supplies. Show your daughter how to use pads or tampons. Don't leave them guessing—teach them.

Healthy Habits and Hygiene

Teach your daughter these healthy habits:

• Wash hands after bathroom visits.
• Clean your genitals and bottom daily.
• Wipe front to back only.
• Wash only the vulva with warm, soapy water.
• Dispose of pads or tampons in the trash; never flush pads.
• Wear cotton underwear to prevent infection.
• Drink plenty of fluids to stay hydrated and avoid UTIs.

Myth Busters

You may remember your grandmother warning that swimming would stop your period or that tampons affect virginity. They may have even said, "Periods are private and not to be discussed." Keep those myths in the past.

Swimming does not stop your period, and wearing a tampon or period swimwear prevents leaks. Inserting a tampon is not a sexual activity. While tampons can stretch or break the hymen, many women tear their hymens during everyday, normal activities like biking. Finally, talk openly about your period— never feel ashamed about your body's natural function. Celebrate your daughter's period as a sign of their growing maturity.