Posts Tagged ‘electronic health records’

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Health Technology Hazards: ECRI’s Top 10 for 2014

January 15, 2014
hazard/jasleen kaur, via Flickr

hazard/jasleen kaur, via Flickr

It’s that time of year again—the ECRI Institute has released its Top 10 Health Technology Hazards for 2014 report, and with it come new (and old) hazards to keep in mind.

Alarm hazards still posed the greatest risk, topping the list at number one for the third year running. Other repeat hazards included medication administration errors while using smart pumps (in at number two), inadequate reprocessing of endoscopic devices and surgical instruments (number six), and, at number eight, risks to pediatric patients associated with technologies that may have been designed for use in adults (such as radiology, oxygen concentrators, computerized provider order–entry systems, and electronic medical records). For an overview on these, see our posts from 2012 and 2013.

And here’s a snapshot of new hazards that made the cut, along with some of the report’s suggestions on how to prevent them.

Radiation exposures in pediatric patients (#3)

The risk: Although computed tomography (CT) scans are valuable diagnostic tools, they are not without risk, and children, who are more sensitive to the effects of radiation than adults, are more susceptible to its potential negative effects. According to the report, new empirical studies suggest that “diagnostic imaging at a young age can increase a person’s risk of cancer later in life.”

Some suggestions: The report suggests that health care providers take the following actions: use safer diagnostic options, when possible, such as X-rays, MRIs, or ultrasounds; avoid repeat scanning; and use a dose that is “as low as reasonably achievable.”

Occupational radiation hazards in hybrid ORs (#5)

The risk: Hybrid ORs, which bring advanced imaging capabilities into the surgical environment, are a growing trend. However, with these angiography systems comes exposure to radiation—a risk to both patients and OR staff.

Some suggestions: According to the report, a radiation protection program is a must. The program should include training for staff, who may not have experience with imaging technology; the use of shielding with lead aprons or other lead barriers; and monitoring of radiation levels. Read the rest of this entry ?

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How Perioperative Medication Withholding Affects Patients with Parkinson’s Disease

February 4, 2013

By Sylvia Foley, AJN senior editor

The timing of antiparkinson medications has pro­found implications for motor and cognitive function.… If perioperative surgical staff aren’t sufficiently aware of the importance of minimizing disruptions to patients’ antiparkinson medication regimens, prolonged medi­cation withholding of several hours’ duration can occur. And patients with Parkinson’s disease whose doses are delayed may deteriorate quickly.

In January and again this month, we bring you a pair of CE–Original Research articles that describe the findings of two companion studies on how perioperative medication withholding affects patients with Parkinson’s disease. Here’s a short summary.

The quantitative study—what the EHRs said. The first article, “Perioperative Medication Withholding in Patients with Parkinson’s Disease,” discusses the results of a retrospective review by Kathleen Fagerlund and colleagues. The authors reviewed the electronic health records (EHRs) of 67 surgical patients who had undergone 89 surgeries unrelated to Parkinson’s disease. They looked at the duration of perioperative withholding of carbidopa-levodopa (Sinemet)—the gold standard treatment for Parkinson’s disease, it has a short half-life of just one to two hours—and at symptom exacerbations.

What they found was that medication withholding tended to be prolonged. The median duration of withholding for 32 inpatient and 57 outpatient procedures was more than 16 hours and more than 11 hours, respectively. They also found that for 56% of the inpatient procedures, the patient’s EHR contained a note referencing Parkinson’s disease symptoms or symptom management, which included increased agitation or confusion, increased tremors, and symptom management complicated by pain or pain medications. (Because outpatient EHRs contained minimal nursing notes and patients were discharged quickly, only inpatient EHRs were reviewed.)

figure_captureThe authors offer several recommendations, which include a call for improved nursing education about Parkinson’s disease; they state,

nursing education should stress the importance of patients continuing to take their antiparkinson medications with a sip of water up until shortly before the initiation of anesthesia, and of their resuming these medications as soon as possible after surgery.

The qualitative study—the patients’ take. The second CE, “The Perioperative Experience of Patients with Parkinson’s Disease,” discusses findings from a qualitative study by Lisa Carney Anderson and Kathleen Fagerlund. Read the rest of this entry ?

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Health Technology Hazards: ECRI’s Top 10 for 2013

January 4, 2013
hazard/jasleen kaur, via Flickr

hazard/jasleen kaur, via Flickr

It’s a new year and with it comes new health care technology hazards to keep in mind, as listed in the most recent ECRI Institute report, 2013 Top 10 Heath Technology Hazards. While some risks from last year’s list made a repeat appearance, a few new topics made the cut for 2013.

Alarm hazards still posed the greatest risk, topping the list at number one. Other repeat hazards included medication administration errors while using smart pumps, unnecessary radiation exposure, and surgical fires. For an overview on these, see our post from last year.

Several new opportunities for harm seemed to involve new information technology (IT) that is making its way into health care facilities, such as smartphones and mobile devices. Here’s a snapshot of several of these, and some suggestions the report gives on how to prevent them.

Patient/data mismatches in electronic health records (EHRs) and other health IT systems

The risk:
One patient’s records ending up in another patient’s file may not be a new phenomenon—it happened in traditional paper-based systems as well. But newer, more powerful health IT systems have the capability to transmit mistaken data to a variety of devices and systems, multiplying the adverse effects that could result from these errors.

Some suggestions: The report suggests that when purchasing health IT systems, facilities should consider how all the connected technologies facilitate placing the right patient data into the right record. It also states that a “patient-centric” approach is preferable to a “location-centric” one. All patient flow and device movement should be kept in mind, as well as planning for all types of transfers (not just routine ones). And during implementation of any project or software upgrade, appropriate testing should be carried out to avoid surprises.

Interoperability failures with medical devices and health IT systems

The risk:
Establishing interfaces among medical devices and IT systems has the potential to reduce errors associated with manual documentation, but achieving the appropriate exchange of data can be difficult, and can lead to patient harm. (For example, interfaces between medical devices may not work properly, systems can be incompatible, and one device can have unintended effects on another.)

Some suggestions: Although there are challenges to integrating medical devices and systems, the report stresses that health care facilities should be actively engaged in the process—albeit cautiously. An inventory of interfaced devices and systems, including software versions, should be kept. Hospitals should follow best practices as described in the International Electrotechnical Commissioner’s standards (available on the International Organization for Standardization’s Web site). When making changes to interfaced equipment, all stakeholders should be involved (and this includes nurses). Finally, before any broad system modifications are implemented, testing should be carried out to ensure everything works as expected.

Caregiver distractions from smartphones and other mobile devices

The risk: While much has been said about the security considerations associated with the use of smartphones, tablet computers, and other handheld devices, another topic that is starting to get attention is the potential for substandard patient care or even physical harm to patients if caregivers are distracted by their devices. Making mistakes or missing information as a result of distraction isn’t the only problem. Caregivers who are distracted by their devices may miss clues about the patient’s condition or cause patients to question the quality of their care.

Some suggestions: According to the report, staff should be educated about the risks associated with the use of smartphones and mobile devices, especially the potential for digital distractions that affect patient care. Hospitals should come up with a “mobile device management strategy” that includes appropriate use of the devices, including specific measures users must take to ensure safety and security. Hospitals may also want to consider restricting personal use of these devices during patient care activities.

Other hazards that topped the list for 2013 include the following:

  • air embolism hazards
  • inattention to the needs of pediatric patients when using technologies that may have been  designed for use in adults (such as radiology, oxygen concentrators, computerized provider order-entry systems, and electronic medical records)
  • inadequate reprocessing of endoscopic devices and surgical instruments

Click here to request a copy of the full report.—Amy M. Collins, editor

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That Acute Attention to Detail, Bordering on Wariness…

November 21, 2011

via Wikimedia Commons

By Kinsey Morgan, RN. Kinsey is a new nurse who lives in Texas and currently works in the ICU in which she formerly spent three years as a CNA. Her last (and first) post at this blog can be found here.

It seems that nursing schools across the world subscribe to certain mantras regarding the correct way to do things. Different schools teach the same things with utmost urgency. Hand washing is one of the never-ending lessons that comes to mind. How many times do nursing students wash their hands while demonstrating the correct way to perform a procedure? I vividly remember actually having to be evaluated on the skill of hand washing itself.

Another of the regularly emphasized points of nursing school is double-checking. One of my first clinical courses required students to triple-check patient identification before giving medications. We were to look at the medication administration record, the patient’s wristband, and then actually have the patient state their name.

As a new nurse learning several new computer systems for charting, etc., I’ve noticed that the old attention to detail, ground into my soul during my school days, now seems easy to overlook, since computers do so much of the work. Of course, computer charting and electronic MARs* have simplified tasks and made time management much less daunting. But sometimes I worry about the hidden cost of such improvements.

I intend, vow, resolve to make an effort to remain aware of how easily errors can happen when we don’t double- and triple-check things. I want to always retain that astute attention to detail, bordering on wariness, so that I can practice as safely as possible, even with the advent of electronic methods.

*MARS = medication administration records

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Open Medical Records: A Question of Safety

August 3, 2010

By Christine Moffa, MS, RN, AJN clinical editor

We’ve all watched our health care provider writing or typing while we answered questions or described our symptoms. Before becoming a nurse I used to wonder what they were putting in my chart and if they got it right. And now that I am a nurse I can’t believe how often a medical assistant or nurse will take my vital signs and write them down without telling me what they are. How can it be possible that adults are kept from knowing their own or their children’s health information? Back when I worked on a pediatric floor my colleagues gasped in shock when I allowed a parent of one of my patients to look at his child’s chart. And I actually let them make me feel like I had done something wrong!

Last week this issue was the topic of a column by Dr. Pauline W. Chen in the New York Times, where two related blog posts (here and here) also received much reader commentary. The sudden flurry of interest in the subject was occasioned by an article published in the Annals of Internal Medicine detailing the preliminary findings of a study following a national project called OpenNotes, funded by the Robert Wood Johnson Foundation, in which “more than 100 primary care physicians and 25,000 of their patients will have access to personal medical records online for a 12-month period beginning in summer 2010.” Readers’ comments ranged from one extreme to the other, such as the following:

  • “The records are the doctor’s; the doctor creates the record. Just as I would create a file on a client, the intellectual property is mine, I can have control.”
  • “As a healthcare consumer, I pay a lot of money out-of-pocket to healthcare providers for the services they render me. I am fully entitled to the documentation produced as part of this business transaction.”

 

Patients finding errors. Last year, as part of our ongoing “Putting Patients First” series, AJN published an article, by Susan Frampton of the Planetree organization, about Griffin Hospital in Derby, CT (there’s also a series of free Webinars, the next of which is on September 21). At this facility patients can view their records either alone or during conferences with their health care providers. In addition to increasing patient satisfaction, this openness about medical records may also improve safety. According to the article,

“At hospitals with open medical records policies, patients viewing their own medical records have identified numerous errors (for example, name, address, allergies, medications, and historical data); a recent study comparing data obtained from postdischarge patient interviews and medical records indicated that patients can help ensure their medical records’ accuracy regarding adverse events, and that the safety of the care provided may be improved when patients can view their records and correct mistakes and omissions.”

What happens at your facility when a patient asks to see their records?

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