Cinahl Information Systems, Glendale, CA

EVIDENCEBASED CARE
SHEET
Authors
Carita Caple, RN, BSN, MSHS
Cinahl Information Systems, Glendale, CA
Hillary Mennella, DNP, ANCC-BC
Cinahl Information Systems, Glendale, CA
Reviewers
Debra Balderrama, RN, MSCIS
Clinical Informatics Services, Tujunga, CA
Nursing Executive Practice Council
Glendale Adventist Medical Center,
Glendale, CA
Editor
Diane Pravikoff, RN, PhD, FAAN
Cinahl Information Systems, Glendale, CA
June 1, 2018
Published by Cinahl Information Systems, a division of EBSCO Information Services. Copyright©2018, Cinahl Information Systems. All rights
reserved. No part of this may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by
any information storage and retrieval system, without permission in writing from the publisher. Cinahl Information Systems accepts no liability for advice
or information given herein or errors/omissions in the text. It is merely intended as a general informational overview of the subject for the healthcare
professional. Cinahl Information Systems, 1509 Wilson Terrace, Glendale, CA 91206
National Patient Safety Goals (The Joint Commission,
2018): Reporting Critical Results of Tests and Diagnostic
Procedures
What We Know
› The Joint Commission (TJC) is an independent, not-for-profit organization responsible for
accrediting and certifying nearly 21,000 healthcare organizations in the United States(2)
• TJC evaluates healthcare organizations (e.g., ambulatory care facilities, behavioral
health facilities, acute care hospitals, critical access hospitals [i.e., rural health facilities
with ≤ 25 beds and patient lengths of stay of ≤ 96 hours], home health agencies,
long-term care facilities, laboratory services, clinician offices providing outpatient
surgery) to verify that they consistently provide high quality, safe, and effective health
care(2)
–Healthcare organizations are evaluated according to standards that are developed with
input from healthcare providers and other professionals, consumers, experts in certain
subject matters, focus groups, and governmental agencies(2)
– TJC standards are based on current research findings; new standards that are
added must be readily measureable, meet or surpass current healthcare regulations,
positively affect health outcomes, and relate either to quality of health care or patient
safety(2)
› TJC National Patient Safety Goals (NPSGs) were established in 2002.(3)
Each year TJC
provides a list of NPSGs intended to improve patient safety(3)
• TJC examines sentinel event reports (i.e., reports of unexpected healthcare events that
result in serious physical or psychological injury or death), healthcare databases, and
medical safety literature to create a list of NPSGs(2,3)
–Some NPSGs are newly created and some are maintained from the previous year(1)
–There are no new NPSGs for year 2018(1)
• Each NPSG contains specific elements of performance (EP; i.e., implementation
requirements) that are measureable evidence- and expert-based strategies for achieving
the NPSG(3)
• Healthcare organizations that do not satisfactorily adopt the safety practices associated
with the NPSGs risk losing TJC accreditation(1,3)
• When the majority of healthcare organizations have satisfactorily adopted the safety
practices associated with an NPSG, the NPSG is incorporated into TJC accreditation
standards(1,3)
› TJC has identified improving the effectiveness of communication among caregivers in
hospitals, critical access hospitals, and laboratories as goal 2 effective January 1, 2018(3)
• NPSG.02.03.01 requires hospitals, critical access hospitals, and laboratories to improve
the reporting of critical results of tests and other diagnostic procedures in a timely
manner(3)
–A critical result (also referred to as a critical value) is a laboratory value or other
diagnostic test result that is significantly outside the range of values considered normal
and could be life threatening if not immediately corrected (e.g., a serum potassium
level that is either significantly decreased [e.g., 2.9 mEq/L] or significantly increased
[e.g., 6.0 mEq/L])(4)
–The purpose of NPSG.02.03.01 is to ensure that critical results are communicated to the healthcare clinician within an
agreed-upon time period so that treatment can be promptly initiated(3)
– Delays and inaccuracies in reporting critical results can result in significant patient harm and death due to treatment
delays and errors(5)
–NPSG.02.03.01 is comprised of the following 3 EPs:(3)
– Healthcare organizations must develop written procedures that
– define the parameters for critical results. TJC has not set definitive parameters for critical results and expects that
determination to be made by individual organizations(3)
– determine by whom and to whom critical results are reported(3)
– Critical results should never be communicated to an answering service or left in a message on an answering
machine(6)
– TJC requires documentation that critical results were communicated to the physician(3)
– determine the time period within which critical results must be reported; this is assessed from the time the results are
available, not the time the specimen was obtained(3)
– Repeat testing of critical values is commonplace but might not be clinically useful. Researchers who reviewed critical
value results from 86 laboratories reported that repeated results were rarely considered significantly different. For
10% of laboratories, repeat testing took an additional 17 to 21 minutes, and 20% of laboratories reported at least 1
adverse patient outcome as a result of a delayed result(4)
– Healthcare organizations must implement the procedures(3)
– Delays and inaccuracies in reporting critical results can result in significant patient harm and death due to treatment
delays and errors. In a review of the literature, the authors note that failure to communicate critical results are
laboratory errors. Laboratory and other personnel must be educated to notify the appropriate healthcare clinician if a
test result meets the definition of a critical result. Documentation and communication processes for reporting must be
audited on a regular basis to ensure quality improvement(5)
– Healthcare organizations must evaluate how well the organization is reporting critical results within the set time
period(3)
› Recommendations for creating a procedure to meet NPSG.02.03.01 include the following:(6)
• Develop a list of critical results, including upper and lower parameters for laboratory results(6)
• Provide clear protocols to determine who is to be notified of critical results and by what method (e.g., telephone, pager)(6)
• Determine the time period within which the critical results are to be reported(6)
–The time period will vary according to the department and test performed (e.g., serum troponin levels to be reported
within 30 minutes; evidence of deep vein thrombosis to be reported within 2 hours)(6)
• Require that critical results are verbally repeated by the person being notified(6)
• Document the date and time the critical results were communicated to the healthcare clinician(6)
• Perform periodic audits to evaluate if critical results are being reported to the appropriate healthcare clinician within the
established period of time(6)
What We Can Do
› Learn about TJC’s NPSG.02.03.01 so you can accurately assess areas in which your healthcare organization needs to
improve communication of critical results; share this information with your colleagues
› Collaborate with members of your administrative team and TJC accreditation team to develop procedures that will enhance
compliance with TJC guidelines and further promote patient safety with regard to improving the communication of critical
results
Coding Matrix
References are rated using the following codes, listed in order of strength:
M Published meta-analysis
SR Published systematic or integrative literature review
RCT Published research (randomized controlled trial)
R Published research (not randomized controlled trial)
C Case histories, case studies
G Published guidelines
RV Published review of the literature
RU Published research utilization report
QI Published quality improvement report
L Legislation
PGR Published government report
PFR Published funded report
PP Policies, procedures, protocols
X Practice exemplars, stories, opinions
GI General or background information/texts/reports
U Unpublished research, reviews, poster presentations or
other such materials
CP Conference proceedings, abstracts, presentation
References
1. The Joint Commission. (2017). 2018 National Patient Safety Goals presentation. Retrieved March 17, 2018, from https://
www.jointcommission.org/2018_national_patient_safety_goals_presentation/ (G)
2. The Joint Commission. (2018). About The Joint Commission. Retrieved March 17, 2018, from https://www.jointcommission.org/about_us/
about_the_joint_commission_main.aspx (GI)
3. The Joint Commission. (2018). National patient safety goals (NPSG). 2018 hospital accreditation standards. Oakbrook Terrace, IL: The Joint Commission. (GI)
4. Lehman, C. M., Howanitz, P. J., Souers, R., & Karcher, D. S. (2014). Utility of repeat testing of critical values: A Q-probe analysis of 86 clinical laboratories. Archives of
Pathology & Laboratory Medicine, 138(6), 788-793. doi:10.5858/arpa.2013-0140-CP (R)
5. Piva, E., Sciacovelli, L., Pelloso, M., & Plebani, M. (2017). Performance specifications of critical results management. Clinical Biochemistry, 50(10-11), 617-621. doi:10.1016/
j.clinbiochem.2017.05.010
6. Satiani, B., & Kiser, D. (2010). Timeliness in notification of critical vascular laboratory test results is part of quality assurance. Journal for Vascular Ultrasound, 34(4), 189-191.
(R)