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Errors can occur at any level or multiple levels. Consider a busy clinical situation and the team leader shouts ‘We need four units of blood’ or ‘Will someone order four units of blood’ while managing an ongoing postpartum haemorrhage (PPH) – what happens? The majority of times nothing – nobody goes to bring the blood! So how can this be improved? Avoid using instructions like the two examples above – remember – nobody is called ‘someone’! Most obviously an individual can be identified to perform the task, by name: ‘Michael can you please order four units of blood?’ If Michael says ‘Yes’ effective communication might be assumed; but not always. What has Michael heard and what will he do? At the moment we do not really know what message has been received. Michael might dash over with a cup of tea as this is what he thought he heard. This may seem a slightly strange thing to happen; but how often in a clinical emergency have you asked for something and been presented with something else? People are less likely to ask questions in emergencies as everyone is busy. This could be the catalyst for an error or precipitate a missed task. So how do we find out what message Michael received? The easiest way is to use specific ‘task allocation’ incorporated within a formal ‘feedback loop’ (also known as ‘closed loop communication’).

Now the conversation goes:

Team leader (Liz):

‘Michael, can you please order four units of blood?’

Michael:

‘Okay, you’d like me to order four units of blood?’

Team leader:

‘Correct’

The loop is finally closed when Michael returns to the room and confirms that the specific allocated task has been done:

Michael:

‘Liz, the four units of blood are ordered and will be here in 5 minutes’

Team leader:

‘Noted Michael – thanks’

We now know that the message has been transmitted and received correctly. For this process to work both parties (the sender and receiver) need to understand and expect it – again demonstrating the need for us to practise and train together. The phrase ‘Will someone …’ is often used to avoid the embarrassment felt when you cannot remember someone’s name. In emergency situations this must be avoided – use alternative ways of attracting attention: you may need to point or wave at the team member! This is never easy, but is absolutely vital if tasks are to be allocated and completed effectively.