Legal nurse consultants see errors that occur during a patient’s care. What are the sources of errors caused by electronic health care records safety as opposed to a healthcare provider? How do errors occur with electronic health records? Consider the impact of people, processes, technology and environment.
People issues affect electronic health records safety
How does this happen? These factors affect safety:
- Knowledge gaps with bar code medication administration and computer provider order entry (CPOE)
- Inexperience with CPOE
- False expectations of clinical decision support system
- Alert fatigue/overriding
- Overdependence on technology
What is the impact on safety or risk?
- Errors with medication administration
- Inaccurate order entry and management
- Perceived accuracy, lack of attention to details
- Data overload, violations in workflow adherence
- Gaps in clinical judgment
Process factors also affect electronic health records safety. Here are some:
- Failure in adherence to BCMA (scanning, overriding, omission)
- Wrong bar code or absent wristband on patient
- Mislabeling of medication with wrong bar code
- Workflow changes
- Coordination in communication among clinicians
- Increased data management
- Additional verification tasks
What is the impact of processes on safety or risk?
These can be the consequences:
- Incorrect medication administration, potential adverse drug reactions and complications. Possible “Never Event”
- Violates 5 rights of safe drug administration
- Potential gaps in care if workflows are not understood.
- Changes in communication can impact transitions in care. Potential gaps in care delivery
- Clinicians experience data overload and impacts critical thinking abilities
- Early execution of orders
Unfortunately the technology that reduces errors can also cause errors. This is due to:
- Poor EHR engineering and design
- Inadequate application testing prior to implementation
- Usability engineering concerns
- Connectivity failures
- Insufficient interface design
- Equipment failures
- Computer cart and devices large and bulky
- Documentation lacks essential data elements
- Low alert specificity
- Unclear downtime procedures
- Delayed /failure to detect duplicate orders
- Lack of skilled resources to deploy/maintain equipment
- Knowledge gaps on use of HIT and EHR application
What is the impact of technology on safety or risk?
- Design doesn’t support workflow, order entry, usability concerns
- Lack of testing and identification of problems prior to Go-Live date. Increased issues post implementation
- Difficult for end users to learn, use and maintain EHR
- Inadequate connectivity of technology with devices and end users
- Lack of or limited availability of data transfer
- Risk of injury, equipment not in service for care delivery
- Possible end user injury, lack of or improper use of equipment
- Possible insufficient data fields from poor interface design, non-compliance with documentation standards
- Limits identification of incorrect, insufficient or duplicate data
- Non-compliance with documentation procedures and patient management during downtime
- Duplicate order entry increases risk of errors, complications
- Limited or unskilled resources inhibits safe use of technology and risks patient care safety
- Inadequately trained staff increase risk of patient safety and compliance with standards
- Ambient noise interference
What is the impact of the environment on safety or risk?
- Increases error rate when staff are not focused and attentive to details
- Impacts critical thinking
What are your experiences with people, process, technology or environmental breakpoints associated with EHR integration? Do you find that HIT contributes to an increase in potential errors and risks associated with patient safety?
Learn about the vulnerabilites of an EHR by joining Dr. Becky Rufo, who wrote this article, and Pat Iyer for a webinar: Electronic Health Records: Are They Safe? Watch the digital download.
Becky Rufo DNSC RN CCRN has served in a system leadership role for 6 Electronic Health Record implementations in a large Chicago health system. She led the implementation efforts of 2 different Tele-ICUs in large Chicago health systems and received national recognition for excellence. She is an Associate Professor in a Graduate Nursing Program in Nursing Informatics. Dr. Rufo has 30 years nursing experience related to clinical, leadership, organizational development, education, and informatics and achieved national recognition in publications, presentations and won 2 awards for excellence in Telemedicine.
Harrington, L., Kennerly, D.,& Johnson, C., (2011). Safety Issues Related to the Electronic Medical Record (EMR): Synthesis of the Literature from the Last Decade, 2000-2009. Journal of Healthcare Management. 56(1). 31-43.