One area identified by the Joint Commission, related to poor communication, is the need to improve the timeliness of the reporting of critical test results and values. In some cases, delay may relate to problems outside of nursing control, such as inefficient or understaffed laboratories, resulting in slow test turnover. Physicians are, understandably, resistant to receiving calls every time a lab test result is received, so the institution must define the following:

• Critical tests: Tests that ALWAYS require rapid reporting, even if results are normal.

• Critical results: A range of results for any test (even routine) that triggers rapid reporting.

Critical tests include laboratory tests, imaging studies, and other diagnostic tests. There are subsets of critical results:

• Results that are necessary to determine a course of treatment.

• Results that would be critical for some but are normal for those with a chronic disease.

• Results that were reported initially and subsequent retesting results show improvement.

Unless an institution has specifically developed a protocol for the various subsets, they are handled the same as critical results with immediate reporting. Critical results must be transmitted immediately upon receiving them. The institution must establish acceptable time lines for critical tests, such as when a physician orders a test to be done “stat.”

Critical test results can be reported to an the institution can demonstrate that the information can be transmitted

immediately to the physician. For example, a report may be given to an office staff person if the physician is at an office. In some cases, results are sent in computerized form directly from the laboratory, and protocol must be established delineating responsibilities in that case. All staff should be aware of reporting requirements, and information about reporting should be prominently.

Ensuring timely reporting of critical test results and values

Check all lab reports when received and verify those that require immediate reporting.

Report verbally or by telephone immediately to the physician or physician’s agent,-back(especiallyrequestingifgivingresults tore an agent and not directly to the physician).

Chart date and time that test results were reported.

Wrong site, wrong procedure, wrong person surgery

The Joint Commission has developed a universal protocol to prevent wrong site, wrong procedure, wrong person surgery. These types of errors, such as removing the wrong leg or operating on the wrong patient, can have devastating

effects and almost always relate to poor communication. Patients undergoing surgery are often concerned about mistakes being made. Some resort to writing “wrong side” —onapracticetheirthatshouldbodiesbediscouraged as it can be confused with correct surgical marking.

Preventing wrong site, wrong person, wrong procedure surgery

Complete pre-operative verification: This step involves insuring that all relevant information and documentation are available, have been reviewed, and are consistent with each other. There is no missing information or discrepancies.

Mark the operative site: The operative site is marked with permanent ink to indicate the right/left distinction or multiple sites, following the protocol established by the institution. The marking must be visible after the patient is prepped and draped, so the marking is on the operative side, (not a warning on the opposite side).

Conduct a time out immediately before starting the procedure: This should be initiated by a designated team member, allowing last minute verification.