Read Back Process Critical Lab Results

Our facility is looking at the read back process for our critical lab values. Currently as the nursing unit is being called with a critical lab value, the computer is printing the value, which the RN/LPN has immediate access to. We are thinking of changing our process to having the lab, cardiopulmonary, etc. call the units to alert them to a critical value being printed so they know they need to get the printed copy off the computer immediately. This way there is no need to have the lab report a value over the phone that might be miscommunicated, the RN/LPN will have direct and immediate access to the printed copy. Does this adequately meet the standard?

NPSG 2A states that for verbal or telephone orders or the reporting of critical test results by telephone, the complete order or test result must be verified by having the individual receiving the order or test result “read back” the complete order or test result.

Implementation expectations state that the individual receiving the order or test result should, when possible, write down the complete order or test result (or enter it into the computer system) and then read it back and receive confirmation from the individual who gave the order or test result.

In the article, Improving Compliance with the 2006 National Patient Safety Goals, Joint Commission Perspectives on Patient Safety, March 2006, Rick Croteau, MD, executive director of patient safety initiatives for the Joint Commission encouraged healthcare organizations to write the order where it belongs to prevent potential transcription errors. Dr. Croteau went on to say that those organizations considering the use of technology to meet NPSG 2A must ensure the system is capable of complying with every step of the read back process within a time frame which supports patient care and safety:

  • Hear the order
  • Write down the order
  • Read back the order
  • Receive confirmation

According to the Joint Commission, healthcare organizations must define what mechanisms are best for reporting of critical test results. How do you ensure the critical test results are retrieved from the computer system/printer in the time frame that supports patient care and safety? Your process will need to assure that the nurse immediately retrieves the results. The healthcare organization must provide assurance that there will be no significant additional delay in reporting the critical test result to the responsible licensed caregiver so that the patient can be promptly treated.

Further, healthcare organizations must measure, assess and, if appropriate, take action to improve the timeliness of reporting, and the timeliness of receipt by the responsible licensed caregiver, of critical test results and values.

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