Critical/Panic Values- JCAHO pt safety goal

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I would like to hear how other hospitals handle this issue and if it allows the nurses to critically think and interpret how quickly it must be reported.

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Specializes in PeriOp, ICU, PICU, NICU.

hello and welcome to the wonderful family of allnurses.com. enjoy your stay, and best of luck to you. :)

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Specializes in Behavioral Health.
I would like to hear how other hospitals handle this issue and if it allows the nurses to critically think and interpret how quickly it must be reported.

I would like to think so, but I'm not sure. For example, in L&D when we have a pt. on mag sulfate, the lab will call with a critical mag level...but in reality it's not even in the therapeutic range yet for someone with preeclampsia.

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Specializes in Cardiac, Post Anesthesia, ICU, ER.

Our hospital just hashed over this one, and the end result was it should be nursing judgement on what labs to call to a physician and which not to call. For example, lab calls because a patient's Trop I level is a 155.6, but it previously was >500, and the patient is post angioplasty. Should I call the doctor to let him know that my now stable post MI patient's labs are returning closer to normal??? Not unless I don't like him!!!! Same thing for PTT values when a patient is on a Heparin gtt, what lab interprets as critical, is often times therapeutic.

The big problem with JCAHO is that no one really knows what the rules really are except for the surveyors. JCAHO needs guidelines that are BLACK and WHITE, without gray areas that are to be determined by a surveyor. In nursing we are expected to have measurable outcomes, etc, JCAHO needs to have "measurable standards!!!"

Doug

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Specializes in Utilization Management.

Our hospital's lab will call almost any critical lab except troponins. I wish they would, though. Easy enough to make the judgment not to call, but you can't even decide if you don't know. I often estimate what time my trops need to be in on a new admit and find that I have to run back and forth from the patients to the computer to check. A phone call would be so much easier to handle, as we all carry cell phones.

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Good grief!! I will have lab call critical values on a potassium level of 5.8 on a hemolyzed sample, yet when reviewing labs I have found lab values of potassium less than 3.5 (I have seen 2.9, 2.3 for example) that are NEVER reported. That's just one inconsistency with our lab calling critical values, there are many others. Despite JCAHO having already been through our place a few months ago, this hasn't changed.

If I feel that the lab result may not be accurate, I'll have it redrawn. For instance I had very high PTT results on a new admit, on no anticoagulants at home, no known medical condition that could relate to this, previous values done in ER were normal. I've never been called on the carpet in these circumstances for redrawing labs.

I always review the previous lab results when making the determination on whether to call the doctor or not. Lab usually only tells me about one abnormal value and not mention others.

JCAHO needs to have "measureable standards"
SEOBowhntr

NO KIDDING!!!! For some reason they are oblivious to obvious safety violations that pose a danger for patients & staff, for example in my place most of the semiprivate rooms are soooo small that you cannot even open the BR door without it hitting the FOB, now how is someone supposed to safely ambulate a pt to the BR? :rolleyes: Or the hallways need to be clear, never mind that we have inadequate storage or I can't get to the suction gage because the chair and bedside locker are in the way in these "cozy" rooms. :smackingf

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Specializes in Vents, Telemetry, Home Care, Home infusion.

from jcaho website:

what is meant by the term "critical test results?" who decides?

this is defined by the individual health care organization and will typically include "stat" tests, "panic value" reports, and other diagnostic test results that require urgent response. for most organizations, this will include all test results reported verbally or by telephone. if a subset of "critical test results" is not defined by the organization, surveyors will consider all verbal or telephone reports of diagnostic tests tobe "critical."

is the term "critical test results" limited to laboratory tests?

no. the term "critical test results" applies to all diagnostic tests including imaging studies, electrocardiograms, laboratory tests and other diagnostic tests and studies.

http://www.jcaho.org/accredited+organizations/06_goal2_faqs.pdf

don't be affraid to speak up and volunteer for those polcy and procedure committees...how i've gotten sensible ones developed.

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