Electronic messaging
Q. We are in the process of updating our system of reporting critical results using BlackBerrys® to send reports to recipients. If the results are visually displayed and there has been no verbal exchange is read-back necessary?
A. Recognizing that there is a rapid evolution in technology that facilitates electronic reporting for this type of situation, the intent of the NPSG requirement remains the same. If the reporting entity utilizes an electronic format (text messaging, email, etc.) to deliver the communication of critical test results, the receiving provider needs to send back a confirmatory electronic or verbal communication to the sender confirming that the provider has received the results. This communication from the provider should contain an electronic signature, or similar identifying electronic notation, that identifies the provider to the sender. The reporting entity should then record receipt of the confirmation in the medical records. Responsibility remains with the provider, or their designated proxy, to process the received information in a timely fashion and to make decisions regarding the need, if any, to adjust the care for the patient based on the test results received. The organization’s policies and procedures should accurately reflect the processes for communication, confirmation, and documentation of receipt. Additionally, these policies and procedures should clearly define responsibility during the process and when the final responsibility for managing the critical test results has passed from the reporting entity to the test-ordering provider.
Physician to physician communication
Q. Does this read-back requirement also apply to physicians, such as when an attending gives a verbal or telephone order to a resident or when a nurse calls a test result to a physician?
A. Yes, it applies to all caregivers, including physicians. The intent of NPSG.02.01.01 is to ensure that orders and directives that would be carried out in a verbal or telephone order are clear to the recipient and confirmed by the individual giving the order. In addition, all verbal or telephone reports of diagnostic tests determined by the organization to be “critical” require a read-back. Simply repeating back the order is not sufficient. Whenever possible, the receiver of the order should write down the complete order or enter it into a computer, then read it back, and receive confirmation from the individual who gave the order.
Read-back is not required when these communications do not include verbal communication of orders or critical test values. The following situations give examples of when read-back is not required.
- Physician to physician consultation (ex: details of consultation is given by a radiologist to the primary physician).
- Dialogue between professionals (i.e. physician to physician – ex: orthopedic physician is giving details of a consultation to a peer or resident).
Scribes
Q. Please clarify the difference between verbal/telephone orders versus orders written by a “scribe.” Do both require a read-back?
A. An order for care that is delivered orally, whether directly or by telephone, must be read back by the person receiving the order regardless of who that is: nurse, transcriptionist, “scribe,” or any other authorized individual. Note that standard RC.02.03.07 requires that only “designated qualified staff” may accept verbal or telephone orders.
Read-back
Q. If I receive a telephone order and repeat it back as I am writing it down, is that acceptable?
A. No. This would be a repeat-back. To be a read-back, the order must first be written or entered into a computer, then it must be read back as it is written.
Emergencies
Q. In an emergency situation such as a code in the ER, if the physician calls out the medication order and the RN repeats it back before administering the drug, and the code recorder is documenting the name of the drug, dose, time, route, and rate, is this acceptable?
A. Yes. In certain situations such as a code or in the OR, it may not be feasible to do a formal "read-back." In such cases, "repeat-back" is acceptable.
Nutrition orders
Q. Does the read-back requirement apply to the Food Service Department when taking verbal/telephone diet orders from nursing?
A. Yes.
Documentation
Q. How do we demonstrate that the read-back actually occurs?
A. The Joint Commission has not established any documentation requirements for this goal. When we survey your compliance with the goals, we may ask how you track performance against the goal, i.e., how do you know that the process is being done consistently? Whatever your method is, which may or may not include some form of documentation, we will take this into consideration as we evaluate your performance based on your approach for tracking compliance.
Voicemail
Q. We have recently heard of voicemail systems that have been designed to support the read-back process. What is The Joint Commission’s position on such systems?
A. The usual voice mail system is not acceptable under this NPSG requirement. However, if a system is designed such that all the steps in the read-back process, including the final confirmation that the read-back information is correct, can be accomplished in a time frame that meets the care needs of the patient/client/resident, then it would be acceptable.
Family members (home care only)
Q. In home care, there are times when the parent or other family member is the patient's primary caregiver. This leads to the family member receiving verbal or telephone orders from physicians when there is no nurse in the home at the time, then communicating the orders to the nurse when she arrives. Is this acceptable?
A. Patients or their family members are not considered physicians’ agents, nor are they qualified by law and regulation in most (if not all) states to receive orders for care. If, in a particular locality, this is legally permissible, then a “read-back” of any verbal or telephone order should be carried out, and the family member would have to be trained to do this.