The ability to speak up to express concerns is a key safety behaviour we should all have working within the NHS. Teaching and using the 'probe, alert, challenge and escalate' (PACE) tool can allow any healthcare professional of any type or seniority to use graded assertiveness to challenge any action or behaviour they may feel is inappropriate or unsafe.
An example of this can be seen below.
A junior midwife and neonatology doctor attend a category 1 caesarean section in obstetric theatre. The baby has been born and the neonatologist is attempting to resuscitate the baby. The heart rate remains below 100 bpm and the neonatologist is unable to inflate the lungs with no chest rise visible. The midwife is helping the neonatologist by listening in to the baby’s heartbeat and checking oxygen saturations. The midwife is becoming increasingly concerned about the baby as the neonatology doctor has become task-focused and believes they are successfully resuscitating the baby.
The midwife subsequently works through PACE until she gets a response from the neonatologist.
Probe: ‘Is the chest rising?’
Alert: This time the midwife speaks louder and using the neonatologists name. ‘[NAME], I cannot see the chest rising.’
Challenge: ‘[NAME], the chest is not rising and the saturations are not improving. I am concerned and do not think this is working. Can I take over?’
Emergency: [NAME], the chest is not rising, the saturations are not rising. I am going to put out an emergency 2222 call for the neonatology crash team.’