3Cs: Coffee, Children, and Cancer

A new grad turned pediatric oncology nurses' jump into the fray…

EMRs…Room for Human Error

on August 24, 2012

Image Credit: waynefarley.com

We live in an age of technology. Having a computer with internet access is a requirement for homework completion these days—I asked my 12-year-old son and he didn’t exactly know what an encyclopedia was. But I bet he could describe—in detail—smartphones and tablets, Bluetooth and wifi, voice-enabled this or that, and GPS-powered watches that track your workouts and sync with your sneakers. Even my two-year old patients have iPads. Want to know how to survive an earthquake?—there’s an app for that.

I’m not complaining—I love my gadgets. I like being able to sync my life over “clouds.” I want to be able to start my BMW (when I get one) with my iPhone. With technology saturating so many facets of our lives it was only a matter of time before it inserted itself into healthcare. Enter the electronic medical or health record (among other technology). Besides the fact that I find written documentation to be lengthy and often redundant, I like EMRs’ simplicity and cleanness—click here, check there…with the option for free form text when the situation necessitates it. There’s also no illegible handwriting to decipher—big plus there. We all have a colleague or two (and it’s not just the docs!) whose handwriting looks more like hieroglyphics. EMRs not only allow us to get rid of all the paper charts and MARs and such, but they allow us to more easily share information between healthcare providers and with our patients, scheduling, billing, everything you need can be built in to be right at your fingertips. But EMRs can have their drawbacks…

At the end of the day computers and software—are just a bunch of codes in a machine. We tell them what to do and well, they’re subject to human error via us being behind the wheel.

Which brings me to the story of Jack and Dr. Jill. Little Jack was ordered 200 mg voriconazole every 12 hours, scheduled for 0800 and 2000. Around 1830 one evening Dr. Jill decided to increase Jack’s dose of vori. She “ends” the current order in the EMR and creates a new order for Jack to receive 300 mg of voriconazole every 12 hours, scheduled for 0800 and 2000. No biggie right? Wrong-O. Jack’s 2000 dose for that night essentially disappeared from the eMAR (and subsequently did not show up as a “due med” for Jack to his night shift nurse), as the order was typed in to start at 0800—which would not occur again until the next morning. In any event, the omission was caught a couple of hours later, Dr. Jill created another order—this one with a start date of that night, and little Jack got his vori a little late. No harm done, and a lesson learned—be careful what you type. The computer reads things literally—if you type for a med to start at 0800 and it’s 1830, it’s not going to start until tomorrow. Doses can also potentially be “lost” when meds are retimed—maybe an antibiotic was to be given for seven days and retiming the doses bumps a dose to an eighth day causing that last dose to sort of drop off. So there are still a few kinks (at least within the eMARs) to be worked out…

Maybe vori being a couple of hours late isn’t that big a deal but in oncology some of our meds are a little more timely. I’m thinking leucovorin after methotrexate, or mesna after ifosfamide timely. *Shivers*

What has been your experience with EMRs? Does your facility have any practices in place to help decrease these types of “near-misses?” Is there a way to build some type of flag or safety net into the EMR itself to catch these? Sharing is caring. For some additional food for thought check out Hannah McCaffrey’s article, Technology Induced Errors a New RN Concern, on DiversityNursing.com.


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