Electronic Health Records

EHR defaults cause medication, patient safety errors

The Pennsylvania Patient Safety Authority’s newest analysis shows troubling news for providers who rely on basic EHR shortcuts such as automatically populated default fields.  While pre-filled boxes are intended to save time during data entry, standardize input, and increase efficiency, users often forget to change the default values, leading to potentially serious medication errors that can cause harm to patients.

“Default values are often used to add standardization and efficiency to hospital information systems,” Erin Sparnon, MEng, patient safety analyst for the Pennsylvania Patient Safety Authority explains. “For example, a healthy patient using a pain medication after surgery would receive a certain medication, dose and delivery of the medication already preset by the healthcare facility within the EHR system for that type of surgery.”

However, wrong dosage amounts, either too much or too little of a given drug, were the most common effect of pre-populated EHR defaults.  Out of 324 incident reports examined by Pennsylvania researchers, 147 were related to incorrect dosing, with 34 of those related to overdoses.  While the vast majority of events were classified as “no harm” incidents, two of the overdose situations, one involving morphine and the other involving a muscle relaxant, did cause temporary harm to the patients and required intervention.

Forty percent of the errors were caused by providers failing to change the default value of a medication order, while 6% of problems were caused by the EHR system overriding a user’s input in favor of the default value.  In one report, a patient failed to receive the proper antibiotic regimen due to the EHR stopping the order prematurely, resulting in a fever spike and the need for the treating physician to make a manual call to resume the medication.

“Many of these reports also showed a source of erroneous data and the three most commonly reported sources were failure to change a default value, user-entered values being overwritten by the system and failure to completely enter information which caused the system to insert information into blank parameters,” said Sparnon. “There were also nine reports that showed a default value needed to be updated to match current clinical practice.”

“The analysis shows that healthcare providers should consider their use of default values in order sets particularly when considering how users see and enter time information, how they address errors related to situations in which default values have not kept up with changes in clinical practice and consider whether EHR software allows users to easily tell the difference between user-entered data and system-entered data,” Sparnon concluded.

To read the full September 2013 findings, including other patient safety risks identified by the Authority, please click here.

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