What type of communication occurs when a healthcare provider prescribes antibiotics (abx) to a pregnant patient, despite it being contraindicated, and another provider notices the error, brings it to their attention, and the first provider responds by saying they will check the contraindications?

Communication Type in Medication Safety Event

This scenario describes a "call-out" communication strategy, where one provider directly voices a critical safety concern to alert another team member about a contraindicated medication in real-time.

Understanding the Communication Framework

The interaction represents a call-out (Option A), which is a structured communication tool used in healthcare to immediately flag safety concerns during time-sensitive situations. 1

Key Characteristics of This Call-Out:

• Immediate alert: The second provider directly notified the prescriber about the contraindication in real-time 1
• Safety-focused: The communication specifically addressed a medication error that could cause fetal harm 2
• Brief and direct: The interaction was concise, appropriate for the urgent clinical context 1

Why This Is NOT Other Communication Types

Not Closed-Loop Communication:

• Closed-loop communication requires three steps: (1) sender transmits message, (2) receiver acknowledges and confirms understanding, (3) sender verifies the message was received correctly 1
• In this scenario, the prescriber's response ("I will check") does not confirm understanding or verify the action—it merely defers the issue 1

Not Check-Back:

• Check-back involves the receiver repeating information back to confirm accuracy, typically used for orders or critical information transfer 1
• The prescriber did not repeat or confirm the contraindication information 1

Not Complete Structured Communication:

• While the second provider initiated appropriate communication, the prescriber's dismissive response ("I'm in a hurry") represents a critical breakdown in the safety communication chain 2, 1

Critical Safety Concerns in This Scenario

Immediate Patient Risk:

• Certain antibiotics are absolutely contraindicated in pregnancy (FDA Category X drugs like fluoroquinolones and tetracyclines after first trimester) and can cause fetal harm including skeletal abnormalities, tooth discoloration, and developmental issues 2, 3, 4
• The prescriber's failure to immediately stop and verify represents a hazardous professional behavior that endangers both mother and fetus 2

System Failure Points:

• The "I'm in a hurry" response indicates time pressure overriding safety protocols—a well-documented cause of medication errors 2
• Lack of immediate action on a contraindication represents a hazardous system failure requiring intervention 2, 1

What Should Happen Next (Critical Action Steps)

For the Alerting Provider:

• Do not accept the dismissive response—escalate immediately to a supervisor or pharmacy if the prescriber does not stop the order 1
• Document the interaction including the contraindication identified and the prescriber's response 2
• Physically prevent medication administration if possible until verification occurs 1

Proper Response Protocol:

• The prescriber should have immediately stopped, verified the contraindication, and either changed the antibiotic or confirmed the medication was appropriate 1
• Safe antibiotics in pregnancy include beta-lactams (penicillins, cephalosporins), which should be first-line choices 2, 3, 4, 5

Common Pitfalls in This Scenario

• Time pressure compromising safety: "Being in a hurry" is never justification for prescribing contraindicated medications 2, 1
• Hierarchical barriers: Junior providers may hesitate to challenge senior prescribers, but patient safety must override hierarchy 1
• Inadequate knowledge of pregnancy-safe antibiotics: Prescribers must know that penicillins and cephalosporins are first-line, while fluoroquinolones and tetracyclines are contraindicated 2, 3, 4, 5
• Failure to complete the safety loop: The alerting provider must ensure the dangerous order is actually stopped, not just acknowledged 1