Acouple years ago, we nearly discharged a patient with a sponge left inside her. The patient had emerged from anesthesia and we were about to transfer her to PACU when we realized she had a retained object. But from our investigation of the near-miss, we found that some staff members were hesitant to speak up when potential patient safety issues arise. Our solution: Encourage staff to CUS in the OR.

• I'm Concerned
• I'm Uncomfortable
• This Is a Safety Issue

Staff can use these phrases to alert surgeons and staff about their concerns. We ordered buttons that say, "We CUS in surgery! Ask me Why." Every surgical team member wears the button on her scrubs or ID badge. Besides serving as a visual reminder to speak up, the catchy phrase also provides opportunities for the surgical team to share with staff members in other areas of our hospital about what they do to protect those in their care.

F. Jean Campbell, MSN, RN
Alton (Ill.) Memorial Hospital
[email protected]