Nurses Raise Alarm Over Epic-Related Safety Errors

EMR transitions are difficult — if not excruciating — for just about every hospital that undertakes them. But one Epic installation at a California hospital seems to be having more than its share of problems, to the point where a med administration recommendation allegedly could have killed a patient.

Recently, nurses at at the prison clinic run by the facility, Contra Costa County Hospital, were about to give a dose of heart medication to an inmate as recommended by the EpicCare system.  Unfortunately, the dose recommended by the EMR might have killed the patient, say the nurses involved.  One nurse caught the error and adjusted the dose before the inmate received the potentially fatal dose.

These nurses are so concerned about the system, which, according to nurse Lee Ann Fagan, won’t let them document medication administration properly, that they’ve gone the county board of supervisors which oversees the hospital’s operations.

According to Jerry Fillingim, a labor representative for the California Nurses Association, “the Epic system decision support technology interferes with the RN’s duty and right to advocate in exclusive interest of their patients,” reported HealthLeaders Media.

Anna Roth, RN, CEO of hospital operator Contra Costa Health Services, told the board of supervisors that the 164-bed county hospital and ambulatory services had just switched to Epic on July 1st, and that the hospital had prepared well in advance for the workflow changes EpicCare would bring.

Nurses don’t seem to agree. According to HealthLeaders, 142 nurses have filed complaints with the labor union, many of which allude to their getting inadequate or incomplete training.

Other executives told Health Leaders that fixes have been made to the system since the go-live date, but that some of those fixes hadn’t been communicated adequately to some staff members.  OK, that may be true, but if the system’s churning out dosing information which is just dead wrong, giving nurses the 411 won’t solve the problem by itself.

Wow.  Just wow. I obviously don’t know how well this county hospital has been run historically, but I’d definitely question whether the workflow planning was all that robust or training even close to adequate.  Meanwhile, I have to wonder what EMR they dumped to bring in a multi-million dollar EpicCare install, and why. Could things have actually been worse before?

About the author

Anne Zieger

Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.


  • Are there any known issues like this in Epic, or is this more likely related to setup and / or training issues? And are nurses administering meds based on recommendations from the software or from orders entered in by doctors?

  • The nurses are quoted as saying they only received 2 hours of training. This is about 1/10th of what is recommended, and would clearly be dangerous.

  • Wow – 2 whole hours. You go and change their whole way of documenting medical care, and being given medical orders, and get 2 hours of training. I’m guessing that no one asked about their workflow, either.

    Is this type of problem common? The one doctor I’ve asked about the same topic told me that in her hospital she received very little training also.

  • Are you telling me that any nurse would rely on a program to tell them how to dispense medications? Doctors, NPs and PAs write the orders. If the nurse follows the orders and has a question about dosing, she should consult the prescribing MD. No one should rely on a program to tell them how much medication to give anyone. Use your head and God given talents if you have them. What ever happen to common sense?

  • Maybe the nurses are asking, and that may be part of what makes everything so slow, that the nurses see errors and have learned to question nearly everything coming out of the system.

  • (repost)Two problems I see with EHR/EMR, and this is from experience….one is companies are not hiring qualified people to do implementations and if/when they do, they try to hard to keep customer happy instead of, implementing the program the way it is suppose to be implemented; what i mean is clients complain and instead of management informing them, trust us this is the best way to do XYZ, they try to make customer happy change things, and what you know, headaches….Two, people just don’t like change, healthcare are employed to help patients not sit at a desk or type on a computer, however the world has changed and so must healthcare, management NEED to inform medical staff, this is what healthcare has come to, we all need to approach it with an open mind and make this thing happen…Lastly, there are people out there who have implemented EHR’s for over 10 years and can help people with workflow analysis, and staffing… just a tip, also CNA’S are more willing to learn, most are young and love technology, they are cheaper than nurse’s and they are taught basic acute care… so think of putting CNA’s on your staff, to operate your EHR and let the nurses take some of the work off the provider and let the provider deal with the major stuff, it works trust me…It’s not the EMR systems although some are better than others, BUT it’s usually not the systems, it’s the users

  • Has anyone experienced this problem with EPIC? I admitted a patient from ED one night about 0100. The DRs orders did not transfer to the floor when I clicked on the Transfer orders report. Because the orders did net transfer to the patients chart on the floor, the patient did not receive all his meds.This error was not discovered until 2 shifts later when the PM RN checked to see if all the admission orders were transferred.I was punished but the AM nurse was not. Management said she was not at fault because there is no policy that states she has to check to see if there is any mistakes made by the preceding RN who performed the admission.

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