Question: Neehr Perfect Activity: Cause and Effect using your knowledge of Neehr

Question

Question: Neehr Perfect Activity: Cause and Effect using your knowledge of Neehr Perfect EHR, identify errors in an EHR chart. Then, using critical thinking skills, formulate possible ways to prevent these health information errors using better health information technology design. Follow the directions provided in the Neehr Perfect assignment, but also create a cause and effect diagram. In order to effectively answer how to prevent these information errors from happening, a cause and effect diagram should be developed.

Application

Log in to the EHR and open the Chart of Cameron Smith

Nurse Four is an experienced nurse working on the medical-surgical unit of the hospital. The medical-surgical unit is especially busy today. Nurse Four is assigned only two patients to begin with because she will be admitting two new patients during the shift, giving her four patients to care for.

When she arrives for her shift (7am-7pm) she is assigned to the following two patients:

* Cameron Smith, DOB 06/22/1975, admitted earlier after a fall resulting in broken ribs and internal bruising.

* Jack J. Jones, DOB 09/22/1945, admitted yesterday for CHF,HTN, and COPD.

By noon, Nurse Four is admitting two additional patients:

*Camron Smith, DOB 06/22/1975, being admitted for pelvic pain, ovarian cysts, 24-hour observation

*Leslie G. Sanderson, DOB 09/12/1975, being admitted for a broken left leg (multiple bones)

The nurse has finished the admission process for Leslie Sanderson. Leslie has been medicated and is resting quitely in bed with her left leg elevated. Nurse Four is now admitting Camron Smth. She added the following information for Camron into the EHR.

*Allergy: Insect sting-bee sting

*Vital Signs: T 98.9, P 90, RR 16, BP 130/84, O2 sat on room air 98%, pain 8/10.

* Order: Obstetric Ultrasound

Now, Nurse Four is about to enter two verbal orders from Dr. One for Camron: Morphine 5 mg IV now. Then in 1 hour may start with Morphine 4 mg IV every 2 hours PRN and ondansetron 2 mg IV every 6 hours. She stops when she notices that there are already orders for morphine and ondansetron in the chart.

With Cameron Smith's chart open in the EHR, take time to evaluate and compare the information in Cameron Smith's Chart in the EHR with the information provided above about the new admission, Camron Smith.

Critical thinking questions:

1. Identify any errors or inconsistencies found between what has been entered in the chanrt and what Nurse Four has been provided to enter. What happened? What other things do you suspect Nurse Four found when she began to look carefully at the chart?

2. These errors are a result of flaws in the design of the EHR. Identify two ways that these HIT flaws, or errors, could be prevented with better HIT design. Be specific in your solution.

3. There are human errors in this chart, where the physician or nurse documented incorrectly. What are those errors?

4. Identify two ways the human error culd be prevented. Be specific in your explanation.

Explanation / Answer

1. ANS: When Dr. One gave Nurse Four the two verbal orders that were for Camron, not Cameron, she assumed that Dr. One was talking about the patient Cameron since their names are very identical in both writing and speech. Nurse Four will most likely find out that Cameron Smith is a male patient, which would lead Nurse Four to realizing that she has the wrong patient as a male would not be getting an obstetric screening.

2. ANS: In order to prevent potential medication errors in which the wrong medication is given to a patient or the wrong patient is given a medication order, whomever is entering the order is required to fully type out the first and last name, middle initial if applicable, and their medical record number in order to enter their chart. It may at first seem tedious but it ensures that the right patient gets the right medication. Another solution could be that every time you select a patient’s chart it prompts the user with a warning if there’s a similar patient currently admitted to ensure that the nurse or whomever is trying to access or admit a patient / chart has the right patient.

3. ANS: An order for an obstetric screening. Allergic to insect stings, specifically bee stings. The vital signs are incorrect except for their pulse, pain scale, height, and weight.

4. ANS: When giving a verbal order the patient’s full name must be said along with their sex and medical record number. The order must then be repeated back to the provider giving the order for confirmation. This may help prevent giving the wrong order to the wrong patient. Another way to prevent human error is to create an auditory messaging system in which the provider or whomever is giving the order send an audio reminder or order to the nurse or whomever is supposed to enter the order. This message would need to include the patient’s first and last name, gender, and current room or medical record number.

Reference:

Working with Health IT Systems (2012) HIT Facilitate Error – Cause and Effect. Health IT Workforce Curriculum. Version 3.0

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