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EHR Design Flaws Contribute to Patient Harm in the ED

Cheryl Clark, for HealthLeaders Media, June 26, 2013

"Half an hour later, you check in on the patient and he is difficult to arouse. 'How many milligrams of hydromorphone did the patient get?' you inquire. The nurse tells you 3 doses of 1 mg each. 'How did that happen?'

"Well, you remember you asked me to give 1 mg of hydromorphone while we spoke in the room, then you ordered another 1 mg in computerized physician order entry with an as needed order for a third."

2. Poor data display

The report says most vendor products list the results in tabular or text format, requiring the physician "to scroll through long tables or lists of results." While some abnormal results are often in bold, in red, or underlined, it's tough for the clinician to distinguish the truly abnormal results from those that are less important.

"It's 10:30 p.m., admitted patients have been stacking up in the ED since the day before, and there is no relief in sight from the crowding. You have 27 patients in your section of the ED, and more than half have results pending from various imaging and laboratory studies. You are waiting for a few critical laboratory values on your sickest patients, and you are scrolling through the "Results" section on the new EDIS.

"You try to review laboratory results for many of your patients quickly and click a button to "accept all" results, which enters the results into individual patient charts. In doing so, you miss an elevated troponin level for a patient who was admitted for a cardiac evaluation."

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Comments are moderated. Please be patient.

3 comments on "EHR Design Flaws Contribute to Patient Harm in the ED"


Pat (7/2/2013 at 2:24 PM)
Nowhere in this report do I see the nursing side of it all expressed. We find things every day that we intervene for before they happen. Human error is present of course, but most of these problems are generated because of the electronic charting. Please include nurses when you look at these problems. They are the ones who are having to deal with catching problems, etc. Several problems required communication but the electronic chart is not the panacea for quality care that everyone wanted it to be. Nurses are so often left out of the equation and they are the key to patient care.

Grif (6/26/2013 at 1:30 PM)
This article brings up some good points, however, the majority of the issues the author attributes to an EHR system are simply brought on by human error. The seven suggestions showcase this fact by primarily addressing preventive actions the ED could be taking.

Mary K (6/26/2013 at 11:39 AM)
The example given for "1. Poor Communication" is incredibly bad. The only time a provider should be giving a verbal order is in case of an emergency (e.g., running a code). Pain for a kidney stone does not equate to an emergency (although it raises everybody's stress levels and it FEELS like an emergency). This is a COMPLETE BYPASS of patient safety[INVALID][INVALID]there is no written order, there is no way for the nurse to verify allergies, to verify the medication and dosage, and how can s/he document giving the dosage if it was verbal? I would not want to be treated in this ED because staff are taking shortcuts in the pretext of alleviating suffering.