Poor nursing communication causes needless hospital injuries and deaths


Nurse-doctor communication is such a problem that the Joint Commission on the Accreditation of Healthcare Organizations requires all hospitals to create policies and procedures to improve nursing communication of critical lab values

June 21, 2010

When a patient is admitted to a hospital one of the most important factors for achieving treatment goals is competent nursing care.

Physicians perform assessments and make orders, and most often then delegate it to the nursing staff to monitor the patient, follow the orders, and report back when there are any changes in the patient’s status.

For nurses to be able to fulfill this role, hospitals must be serious about their role to hire only qualified nurses and then to use proper testing and assessment to ensure that those nurses have the skills to take care of particular types of patients.

In other words, to meet its responsibility under the law, a hospital must have policies and procedures in place to ensure that all of the nurses it hires demonstrate competency in certain basic skills before they are assigned to care for patients independently.

These skills include things like medical record documentation, and taking blood pressure and pulse. But then the hospital must also have policies and procedures to verify unit-specific competencies, in addition to the general skills demonstrated at hiring.

For example, nurses hired to work on a labor and delivery unit need different skills from nurses who work on a neurosurgery unit. And once the general and unit-specific competencies are in place, the hospitals must provide charge nurses, a nurse executive, and other experienced nurses to supervise the bedside nursing care.

Clinical competence is just one of two prongs needed, though, for nurses to fulfill their part of the nurse-physician team effort—the other is communication.

Study after study has shown that poor communication leads to a shocking number of avoidable hospital injuries and deaths. In fact, the organization that accredits hospitals, the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) realized that communication was a major problem that required nationwide correction. JCAHO conducts surveys of hospitals on a regular basis and publishes standards that hospitals must meet in order to receive accreditation.

JCAHO uses its National Patient Safety Goals to “highlight problematic areas in health care and describe evidence and expert-based consensus to solutions to these problems.” To receive or maintain accreditation, hospitals must comply with the specifics of the National Patient Safety Goals, unless they apply for and receive permission to utilize and alternative method.

In 2006, JCAHO used the National Patient Safety Goals to tackle communication problems head-on, specifically as they relate to communication and handling of critical lab results.

Before getting into the new JCAHO standards, let me share two real-life examples of the critical lab value communication problem from two Memorial Hermann hospitals in Houston.

Hyponatremia (low serum sodium level) is a very serious, life-threatening condition for post-neurosurgical or head trauma patients. In such patients, any serum sodium level of less than 130 mEq/L is critical and life-threatening, and required immediate nursing communication to a physician, so an assessment and intervention can be achieved.

In one case, a patient who had undergone a craniotomy to drain a brain abscess was on a general floor. A serum sodium level of 124 was returned by the lab, but the nurses did not communicate it to the physicians. Similarly, a second sodium lab value came back at 121, and no physician was notified. As a result, there was a delay in treatment and the patient now has a permanent, severely disabling brain injury.

In another case, a patient sustained a head injury when he fell off a horse. His serum sodium level fell to critical lab values, but the nurses did not notify a physician. When a physician’s assistant noticed it, she ordered a treatment and then ordered a repeat sodium lab and asked to be paged when the value was available. When the repeat lab came back with a critical lab serum sodium lab value, the nurses notified no one, and the patient ultimately developed a permanent brain injury.

JCAHO recognized this frightening nationwide trend and adopted National Patient Safety Goal 2 to “improve the effectiveness of communication among caregivers.”

JCAHO National Patient Safety Goal 2 Requirement 2A mandates that hospitals develop policies and procedure to require, “For verbal or telephone orders or for telephonic reporting of critical test results, verify the complete order or test result by having the person receiving the order or test result "read-back" the complete order or test result.”

JCAHO National Patient Safety Goal 2 Requirement 2C specifies that hospitals must, “Measure and assess and, if appropriate, take action to improve the timeliness of reporting, and the timeliness of receipt by the responsible licensed caregiver, of critical test results and values.”

We applaud JCAHO for taking patient safety seriously and for holding hospitals accountable for doing the same thing when it comes to proper communication between nurses and doctors.

When hospitals do not assess the competency of their nurses, and nurses do not communicate key findings to a physician, there are serious consequences that can lead to avoidable patient injury and death.

The Texas medical malpractice trial lawyers at Painter Law Firm Trial help families who are forced to deal with this type of medical malpractice. Contact us at 281-580-8800 for a complimentary evaluation of your potential case.

Robert Painter

Robert Painter is an attorney and member of Painter Law Firm PLLC.


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