Study highlights role of EHRs in pediatric medication errors
- Prescribing medications for kids requires unique considerations such as lower body weight, which could lead even small errors to cause patient harm. Yet little is known about how EHR usability issues affect medication errors, a new Health Affairs study says.
- Raj Ratwani of MedStar Health's National Center for Human Factors in Healthcare and other researchers analyzed 9,000 patient safety reports from three healthcare organizations from 2012 through 2017. Of those, 36% had an EHR usability issue associated with the medication error, and 18.8% may have resulted in patient harm.
- System feedback and visual display were the most common usability issues. The most common medication error was improper dosing.
EHRs are rarely implicated when patients are harmed, but it does happen. According to a 2017 study by The Doctors Company, EHRs factored in 66 malpractice claims between July 2014 and December 2016, up from just two between 2007 and 2010. Of those, about a third involved diagnosis.
Half of the malpractice claims revealed problems with the EHR systems themselves, including design issues, lack of integration of hospital EHRs and absence or failure of alerts and alarms.
The 21st Century Cures Act directs the Office of the National Coordinator for Health Information Technology to develop a voluntary program to ensure EHR certification accounts for issues unique to pediatric care. Yet despite near ubiquitous use of EHRs in prescribing medications and clinical decision support, little has been done to distinguish pediatric patients from adults.
According to the new study, nearly a fifth of the medication error reports that involved a usability issue reached the patient. Of those, one-third did not result in harm, 17.9% required monitoring or an intervention to prevent harm, 3.3% caused temporary harm and 45.8% had unknown consequences.
Usability challenges were similar across study sites. System feedback figured in 82.4% of the events, with visual display (9.7%), data entry (6.2%) and workflow support (1.7%) as other factors.
Leapfrog developed a tool to assess the functionality of clinical decision alerts. "Equally important as appropriate EHR functionality is ensuring usability," the authors write.
They also call on ONC and the Joint Commission to address pediatric safety issues in regulations and hospital accreditation requirements. "Given the Joint Commission's critical role in hospital accreditation for Medicare, criteria from the organization on EHR safety would significantly catalyze progress on a national scale," the authors say.
In a separate Health Affairs study, researchers describe how EHRs can be leveraged to detect and predict patient safety using real-time data. The researchers developed a patient safety active management system (PSAM) in a Patient Safety Organization and piloted it at two large community hospitals between 2014 and 2017. The PSAM flagged adverse event outcomes and used EHR data to develop a real-time safety predictive model.
In the two hospitals piloting PSAM, the number of harms detected increased 10-fold. Among other issues, the study showed "important linkages between patient outcomes of in-hospital mortality, length-of-stay, and thirty-day readmission and critical safety measures such as triggers, adverse events, and safety predictive scores," the authors write.
The study raises a number of policy considerations, including ensuring the interoperability of EHR data and the possibility of more FDA oversight if hospitals use EHRs as a "black box" to support clinical decisionmaking at the point of care, the authors say. They also call for more research on how to most effectively use the data to improve patient care.