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EHR Design Flaws Contribute to Patient Harm in the ED

Cheryl Clark, for HealthLeaders Media, June 26, 2013

3. Wrong order/wrong patient error

"You are caring for several patients and have just left the room of an agitated 34-year-old woman who is withdrawing from alcohol. You go to your computer, open the patient tracker, and intend to order 2 mg of intravenous lorazepam for the patient. While in the process of preparing to enter the order, you are interrupted to 'sign' an ECG of a 65-year-old man with chest pain who has just arrived by ambulance.

"You are concerned about a possible ST-segment elevation myocardial infarction, so you hurriedly enter the order for lorazepam and proceed to go

to the room of the chest pain patient. The lorazepam order is inadvertently entered on another patient, an 80-year-old with congestive heart failure, who is also one of your current patients and whose name is listed on the EDIS tracker. The patient has a near respiratory arrest and needs to be intubated."

The report adds that although such errors happen with paper-based systems, "an alarming number of clinicians are anecdotally reporting a substantial increase in the incidence of wrong order-wrong patient errors while using computerized physician order entry components of information systems."

It adds that "there are few consistent data on how commonly these errors occur, and few studies are actually focused on collecting evidence of these errors."

4. Alert fatigue

The volume of frequent alerts and warnings "can dull the senses, leading to a failure to react to a truly important warning," the report says. Unfortunately, the panel says, "the effect of alert fatigue on clinical decision support and computerized physician order entry has largely focused on patient care outside the ED" though it happens all too often inside the ED as well.

" 'Warning! The patient has a documented allergy to penicillin. You must enter a reason why you wish to proceed with your order of cefepime.'

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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.