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Compliance with JCAHO's new read-back goal for critical test results requires education, oversight

Nurse Leader Weekly, October 9, 2003

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A new item in the Joint Commission on Accreditation of Healthcare Organizations' (JCAHO) 2004 National Patient Safety Goals is that nursing staff must read back verbal critical test results, in addition to reading back verbal and telephone orders.

Reading back critical test results, the new requirement for Goal #2, makes sense and is consistent with requirements from the College of American Pathology (CAP) for certain specimen results, says Linda Pello, RN, MBA, CPHQ, director of quality improvement at the Hospital of St. Raphael in New Haven, CT.

St. Raphael's staff comply with CAP requirements for documenting read-back of identified specimens. Staff members use a list of critical lab values that require a telephone call to a patient care unit. Staff members must document these values when they repeat back test results. The hospital plans to educate staff about the importance of reading back critical lab results, says Pello. The hospital will work on creating an electronic system where nurses can indicate that they read back critical test results.

The list of critical lab results to which St. Raphael's laboratory staff will draw attention include, but are not limited to, the following:

• High or low potassium levels
• High or low liver functions
• High levels of acetaminophen or certain other medications
• Abnormal platelet counts
• Abnormal pH levels

At the Parkview Medical Center in Pueblo, CO, staff will focus on educating nurses about confirming critical test results with the lab before informing the physician, says Judy Sikes, PhD, Parkview's director of accreditation and medical staff services.

A "BOJ Talk" group user found it difficult to get nurses to consistently write down "rb" when they read back a verbal order. Instead, the user's facility trained nurse managers to monitor conversations at different nursing stations to determine how often the nurses follow the read-back policy. Managers keep a log of how many times they watch a nurse take a verbal order and how well the nurse follows the procedure. The managers note if the verbal order was confirmed, notice how receptive physicians are to nurses who read back orders, and contact one of the facility's leaders if a physician refuses to cooperate with a nurse during a read-back.

"Reading back critical values is something that everybody should be doing and probably [is] doing," says Pello. "The hard part is coming to consensus on what to include in the read-back requirements because, as I understand this goal, it applies to all tests, not just lab results," says Pello. "That is a very realistic goal and should be part of our everyday practice."

Adapted from Briefings on JCAHO: http://www.hcmarketplace.com/Prod.cfm?id=16

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