Children's Hospital and Regional Medical Center
(Clinical Policy/Procedure: C )
Critical Test Result/Value Reporting Requiring Read-Back
POLICY:
Critical results reported verbally or by telephone will be read back to the person reporting the results, thus providing verification of the test result heard. These results will be reported immediately. Audit documentation will support that the communication has occurred within one hour of confirmation.
PURPOSE:
To promote accurate and timely communication of critical test results.
PROCEDURE: I.
Definition of Critical Test Result/Value: A.
II.
A critical test result/value is one that deviates from defined medical and analytic criteria and which has not been present on an immediate preceding examination and whose value reflects a potential life threatening situation and may necessitate an urgent response.
Communicating Critical Test Results/Values: A.
B. C.
D.
Critical test results will be verbally provided to a licensed care provider responsible for the care of the patient whose result is being reported. To verify accurate transfer of verbal information, staff reporting a critical test result(s) will first confirm the care provider / patient assignment, and then ask the patient’s care provider to write down and read back the patient’s name, medical record number and test result. The reporting staff will use the following script: I have a critical result to report. You will need to write down and read the information back to me to verify accuracy. Any person receiving a critical test result will write down and read back for verification. The receiver of the critical test information will communicate the result as appropriate to the responsible provider or follow an existing guideline of care for action. To ensure timely communication of critical test results/values, the following escalation will occur in rapid succession if initial contact is not available: 1. Inpatients: Patient’s Nurse → Charge Nurse → Responsible House Staff Officer → Patient’s Attending Physician or covering physician 2. Outpatient (Children’s Clinics): Patient’s Clinic Nurse → If no nurse or after hours, patient’s Attending Physician or covering physician 3. Community Outpatient: Patient’s Community Provider or covering physician 4. Children’s Emergency Department Patient: Patient’s Nurse → E.D. Communication Specialist Nurse → E.D. Attending Physician 5. In all cases, failure to reach a responsible house officer, attending physician or community physician will lead to contact with the pediatric chief resident. Failure to reach the pediatric chief resident will lead to contact with the Medical Director or designee.
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Page 2: Clinical Policy/Procedure: Critical Test Result/Value Reporting Requiring Read-Back
E.
III.
Note: The most common practice is to report critical Radiology or Cardiology findings directly to the Ordering/Attending Physician/Provider. When that provider is unavailable, the reporting provider would follow the reporting department escalation process as outlined to expedite communication of the critical result to another provider associated with the patient’s care. In highly emergent cases where read-back would be impractical or impede patient care, repeat-back is allowable. In this situation, the write down step may be eliminated.
Department Specific Critical Test Results: A. B. C. D.
APPENDIX I: APPENDIX II: APPENDIX III: APPENDIX IV:
Radiology Laboratory Cardiology EEG
Originated by: Jennifer Abermanis, M.S., Administrator, Clinical Systems and Logistics Reviewed by:
John Salyer, RRT, MBA, Director Respiratory Care QI Coaches National Patient Safety Goal #2 Workgroup (Jennifer Abermanis, Chair)
Revised by:
Approved by Medical Executive Committee: 2/05
APPROVED BY:
Richard Molteni, MD Vice President & Medical Director
ORIGINATED: REVIEWED: REVISED:
Susan Heath, RN, MN Nurse Executive
2/05 6/06
Additional Key Words: Patient Safety, Patient Safety Goal, Sentinel Event, Radiology
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APPENDIX I: Radiology I.
Specific Critical Read-Back Findings: A. Central nervous system: 1. Brain herniation or impending herniation. 2. Acute ventricular dilation. 3. Unsuspected intracranial hemorrhage, infarction or edema. 4. Spinal cord transection or compression. B. Chest: 1. Pneumothorax. 2. Pneumopericardium. 3. Unsuspected airway or esophageal foreign body. 4. Tracheal narrowing of greater than 50%. 5. Aortic rupture and/or dissection. C. Abdomen: 1. Pneumoperitoneum. 2. Pneumatosis. 3. Portal venous gas. D. Musculoskeletal system: 1. Gas in soft tissues. 2. Signs of child abuse.
(Approved 02/05; Revised 06/06)
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APPENDIX II: Laboratory Hematology Critical Values: Platelet Count WBC HCT
Low < 30,000/CMM < 1000/CMM 15%
Coagulation Critical Values: PT INR PTT Fibrinogen
> 30 sec > 2.8 > 120 sec < 50 mg/dL
High > 1,000,000/CMM > 50,000/CMM 68%
Chemistry Critical Values: Sodium Potassium < 2 days > 2 days Chloride CO2 Phosphorus Serum Osmolality Glucose Newborn (0 – 1 month) Infant (I month) - Adult Calcium
Low 115 meq/L
High 160 meq/L
≤ 3.0 meq/L ≤ 3.0 meq/L 70 meq/L 10 meq/L 1.0 mg/dL < 265 mOsm/kg
≥ 6.5 meq/L ≥ 6.0 meq/L 130 meq/L 40 meq/L 12 mg/dL > 320 mOsm/kg
700 mg/dL 14 mg/dL
Ionized Calcium Bilirubin BUN Magnesium pH (blood) pCO2 pO2 0 - 3 months 3 mo. - Adult all ages
< 0.75mmol/L
1.75 mmol/L 20 mg/dL 100 mg/dL > 5.0 mg/dL > 7.60 > 70 mmHg
< 1.0 mg/dL < 7.20 < 20 mmHg < 30 arterial mmHg < 50 arterial mmHg < 30 capillary mmHg < 20 venous mmHg
TSH Birth – 3 days 3 days – 1 month TDM Critical Values: Amikacin Caffeine Carbamazepine (Tegretol) Chloramphenicol
25.0 uIU/mL 10.0 uIU/mL High Result > 35 mcg/mL > 30 mcg/mL > 13 mcg/mL > 25 mcg/mL
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TDM Critical Values: Cyclosporin A Digoxin Gentamicin Lamictal Lithium Phenobarbitol Phenytoin (Dilantin) Salicylate Theophylline Tobramycin Vancomycin Zonisamide
High Result > 600 ng/mL > 2.5 ng/mL > 12 mcg/L >20 mcg/mL > 2.0 mmol/L > 50 mcg/mL > 25 mcg/mL > 40 mg/dL > 25 mcg/mL > 12 mcg/mL > 50 mcg/mL > 45mcg/mL
Microbiology: Positive Blood and CSF Cultures and CSF gram stains will be called to the patient’s nurse, or if unavailable, the charge nurse. The nurse is responsible for notifying the physician. 1. The first positive blood culture vial(s) of the day is to be given a telephone report. Any subsequent positive vials showing the same organism from the same day or the same patient (24-hour period) will be referred to the first reported vial with no additional telephone report. 2. Any new positive vial(s) of different date after 24-hour period of initial phoned report is to be given an independent telephone report of the day regardless of organism identification. 3. Any new findings of a second organism different from the initial telephone report is to be given an independent telephoned report immediately as soon as the difference is determined. Reference Laboratory Results Laboratory test results defined as critical (alert) by a Reference Laboratory will be called to the care provider.
(Approved 02/05; Revised 06/06) C:\Documents and Settings\shalse\Desktop\TEMP FILES\pdfs\Critical Test Results_Value Reporting_Read Back 153-04.doc (sh:jjcm) © 2006 Children’s Hospital and Regional Medical Center All Rights Reserved
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APPENDIX III: Cardiology I.
ECG / Holter: A. Ventricular fibrillation, Torsades de Pointe, bi-directional ventricular tachycardia, severe 3rd degree AV block or long QTC or sinus node dysfunction or ventricular tachycardia or wide QRS tachycardia.
II.
ECHO: A. Severe conditions of aortic, pulmonary and truncal valves, including aortic insufficiency, aortic stenosis, dysplastic pulmonary valve, homograft insufficiency or stenosis, pulmonary insufficiency or stenosis, truncal valve stenosis. B. Severe conditions of the aortic, systemic artery, pulmonary and coronary circulation, including absent pulmonary or coronary artery, left coronary from pulmonary artery, A-P window, abnormal origin of coronary artery, coarctation of aorta, interrupted aortic arch, myocardial ischemia/infarction, pulmonary embolus or thrombosis, primary or secondary pulmonary hypertension, systemic A-V malformation (large). C. Severe restrictive, dilated or hypertrophic cardiomyopathy. D. Pericardial effusion (large), pericarditis (acute, severe), cardiac tumor. E. Total anomalous pulmonary venous return (cardiac, infracardiac or supracardiac, severe pulmonary vein stenosis or obstruction. F. Arrhythmogenic right ventricular dysplasia, hypoplastic ventricle, single ventricle, severe ventricular dilation or dysfunction or hypertrophy.
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Page 7: Clinical Policy/Procedure: Critical Test Result/Value Reporting Requiring Read-Back
(Approved 02/05; Revised 06/06)
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APPENDIX IV: EEG I.
Specific Critical Read-Back Findings: A. An electrographic seizure recorded on EEG, with or without clinical correlate, for all inpatients and for outpatients not on anticonvulsant medication.
(Approved 02/05; Revised 06/06) C:\Documents and Settings\shalse\Desktop\TEMP FILES\pdfs\Critical Test Results_Value Reporting_Read Back 153-04.doc (sh:jjcm) © 2006 Children’s Hospital and Regional Medical Center All Rights Reserved
