Critical Thinking- Week 10

The registered nurse (RN) is reviewing orders and completing the medication reconciliation (Med Rec) in the electronic Medical Record (EMR). Med Rec is a process for double checking medications, where the RN verifies that the details of the medications written on the provider's orders match those recorded in the medication administration record (MAR) used by the nurse. During the Med Rec process, several alarms/alerts go off.

·         Does the use of EMR guarantee error-free patient care? If yes, why? If no, why?

The use of EMR most definitely does NOT guarantee error-free patient care. I actually worry these standardized systems of EMR charting means care won’t be individually tailored to the patient (i.e. specific health issues of patients won’t be factored in; certain medications they are taking won’t show up and prompt the physician to be careful on what they are ordering; maybe the patient has a blood clotting issue like Factor 5 and the physician won’t notice this since it was entered in a big long list for the medical history and doesn’t stand out amongst the others; doses may not be weight-based since the physician can just use the CPOE drop-down menu and accidentally order/prescribe it for the patient without thinking about their weight or age (i.e. adult vs pediatric doses)). I feel like it is so easy to just click through things on computers without actually reading the prompts or what it is saying. This can be hazardous for patient care. This is why I am glad alerts are generated at times to help staff members think through what they are doing and ask themselves if what they are doing/charting is really safe or not.

EMR is definitely a more efficient way to enter, store, collect, and share information, but it does not mean it is error-free. It requires just as much diligence from nurses as does the old-fashioned hand-written charting.   

·         What types of nursing behavior regarding the use of EMRs might contribute to jeopardizing patient safety?

Nurses getting sloppy and not thoroughly reading computer prompts, such as just clicking through them to get to more familiar screens or cancelling/silencing alarms, are types of behavior that can contribute to jeopardizing patient safety.  

Nurses can be reluctant to change from paper to computer charting because they are set in their ways. They may avoid becoming educated or familiar with the computer charting system and this can lead to error-prone charting on patients.

Due to the ease of computer charting, some nurses may purposefully procrastinate and leave their charting to the end of the shift. This sets them up for making more mistakes because they may forget very important details about the patient’s status and critical information will be missed for continuity of care because of the nurse’s accidental omission.  

·         What are the dangers of excessive system alerts in computer charting systems?

Too many system alerts in computer charting systems can lead nurses to quit reading them and do anything to just silence the alarms such as skipping through alerts quickl. Ignoring these alarms results in increased mistakes that affect patients and communication among healthcare personnel.

·         How can the nurse guard against the potential effect? 

Nurses need to be more diligent in their charting and reading of the electronic health record. They must slow down and read each prompt and be familiar with and educated in the computer charting system. If not, they are more prone to charting on the wrong patient by simply clicking too close to another patient’s name by accident, they may neglect to chart important patient information, or they may just browse through information too quickly without thinking about the alarms/alerts relevance or importance.