Study: EMR Default Med Settings Can Cause Harm To Patients

EMR default settings for medications caused adverse events in more than 3 percent of cases reviewed by the Pennsylvania Patient Safety Authority in a recent study, reports Healthcare IT News.

Researchers with the PPSA analyzed 324 EMR default values (preset medication, dose and delivery) that led to adverse events, in an effort to provide the state’s healthcare facilities with data that could help them avoid such problems. Of the total, six errors were led to what were deemed “unsafe conditions”, while 314 events were reported which generated no known harm to the patient.

Researchers found that the most commonly reported error types were wrong-time errors (200), wrong-dose errors (71) and inappropriate use of an automated stopping function (28).

In theory, default values are there to make medication dosing more standardized and efficient in hospitals. But there are situations in which presets can actually cause harm if they’re not used properly, Healthcare IT News said.

For example, in one report, a patient’s temperature shot up after a default stop time automatically cancelled an antibiotic. In another case, a patient’s sodium levels kept rising because a default note to administer an antidiuretc was marked “per respiratory therapy”; nurses, in response to that note, failed to administer the drug since they incorrectly believed that respiratory therapy was giving the patient the drug.

Another two reports involved temporary harm that called for treatment or intervention by clinical professionals. In one case, a patient got a muscle relaxant dose much higher than intended, and another involved administration of an extra dose of morphine too close to the patient’s last dose.

According to a PPSA statement cited by Healthcare IT News, many of these error reports involved a source of erroneous data, most commonly failure to change a default value or user-entered values being overwritten by the system. Errors also took place when a user failed to enter information completely, which caused the system to insert information into blank parameters.

As useful as these observations are, they just scratch the surface of what can be done to improve EMR safety. Hopefully, the new HHS Health IT Patient Action and Surveillance Plan will address and even cure issues that lie beyond the scope of Pennsylvania’s efforts.

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.

3 Comments

  • Bad idea to allow any healthcare system “. . . to insert information into blank parameters.”

    This is why we have rule sets that can prompt a user for missing information at the time they try to leave an order form.

    The way around the situation where an order must be processed (i.e generate prescription) but the information is not available is to have pre-conditions on downstream workflow steps such that when the time comes to, for instance, administer a medication that others have prescribed, the system trips up the user who then needs to consult with a peer or supervisor to correct the deficiency.

    In the example we see that there are two separate rules in operation – one at the “generate meds” stage and a second one at the “administer meds stage”.

  • I would like to see a study comparing the frequency of adverse events when using an EMR with default med settings versus using a paper chart versus using an EMR with no default med settings. Which settings would have the highest frequency of adverse events?

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