Computerized Charting Errors-Need Stories

[nurse4me8897]

Hi Everybody!

I'm doing a presentation on pitfalls of electronic medical records, and I am focusing on errors unique to computerized charting that nurses need to actively protect themselves from. I could really use examples of errors, or near errors, by nurses that were made specifically d/t computerized charting. I can use personal examples or if you post links to internet articles that would be great too. If you give a personal example, I would appreciate it if you could include the city/state or hospital that it happened in and it would also help to know what happened to the nurse. Some of my subjects are: charting under someone else's name, med errors, issues with drop down menus, inaccurate charting d/t lack of appropriate choices, CPOE... anything along that line. I want this presentation to shed light on EMR issues/dangers that we may not even be aware of, so that we can protect ourselves. Any help is greatly appreciated!!!

[nurseprnRN, BSN, RN]

Just curious but what are you trying to prove with this presentation? Most people are in favor of EMRs and you don't really hear much against them

Not so. There is an increasing body of evidence that shows problems with electronic medical records. I review records for a living and the errors I see that are then promulgated forward in perpetuity because people do the automatic copy-and-paste are amazing. There's another thread on this somewhere around here, examples of charting being carried forward inappropriately, like "pedal pulses present bilaterally" on someone with a BKA.

I reviewed a chart on a patient with traumatic brain injury who went to the OR about 8 weeks post injury for increasing problems because the intracranial shunt was clogged. They fixed it but while they were in there they discovered a small aneurysm in the neighborhood, an incidental finding, they weren't looking for it but there it was, so they clipped it so long as they were in there to fix the shunt. It never bled and had never caused a speck of trouble-- all the trouble was from the trauma.

And somehow when the resident dictated the discharge note from this shunt revision admission he said that this person had had a new intracranial bleed from the aneurysm, which was then clipped. Didn't happen. But it was carried forward in all the medical records and admission and discharge summaries for the next four years (to the present). I can't get anybody to take it out, and those records have been copied to so many places you'd never get them all anyway.

[Twinmom06, ASN, APN]

the only issue I've ever really had was with meds that scan and you sign off that you gave and then an hour later they show up overdue and show as not scanned. Toradol is the main culprit

[wanderlust99]

I am very much in favor of EMRs. The only problems I have seen is when hospitals don't convert to EMRs the proper way. Or when they only do it in phases. Like doing scanning of meds last, when it is the most important phase! Or when hospitals are scared to upset certain physicians so they will put off conversions or allow certain docs to get away with not putting in orders, etc...

I have had docs enter orders on the wrong patient before, but only a handful of times in 10 years of using computerized order entry. And I have noticed some nursing errors when copying pasting previous assessments and not double checking before saving. I have seen LEFT entered instead of RIGHT post op doc note...the manager caught it. I guess that could happen with paper. But that's about it.

I think security and privacy is a big issue too.

[rnforforty]

Nurses who didn't chart well when every thing was handwritten are now even worse with electronic charting. Now all they need to do is "ok" the choices made on the previous shift. Having had to trace infections in 'migrating' IV sites and Foley caths that the 'Foley fairy' placed in the patient while in the elevator during transfer to other units, I can honestly say that the EMR hasn't improved charting in any way.

And I have not been in any facility yet where the med scanner actually worked! The only 'duty' I've seen nurses perform is fighting with the computer/scanner to get the meds administered. Took a nurse 20 minutes once to get my hubby's 3 pills to him! Cost effective? A good use of time for a highly educated nurse? Any more it appears a trained monkey could pass meds - it's been years since I or any nurse I know have actually had to figure dosages or solutions. It all come premixed, measured and packaged! The only thing I saw the nurse do during that hospitalization was argue with the computer. My hubby went 8 days without a bath or any other ADL's (I worked nights at another facility). So let's talk about how the EMR has improved patient care!

[nurseprnRN, BSN, RN]

:: snicker :: the Foley fairy, I love that!

[wooh, BSN, RN]

It sounds like OP wants things that are easy to mischart. It's sooooo easy now to accidentally chart in the wrong chart. I know it's always been a possibility, but I know that I'll find myself a lot more often get to the bottom of my assessment and realize i have to delete it all and put it in the right chart.

For funny things, I often see babies charted as alert and oriented to person, place, and time. I always wonder how the person charting that found out. Like do they speak baby?

[Karou]

The most common errors that see always involve copy/paste.

Ex. Patients "goal" of the shift is, "NPO after midnight, I&D tomorrow at 09:00" charted the day of procedure at 10:00.

I have a LOT of problems with this. First, since you (oncoming RN) copy/pasted my assessment, I wonder if you even actually assessed the patient. I get so irritated when I see a nurse exact copied/pasted and it's no longer accurate.

Ex. On my assessment (19:30), patient found with labored breathing, rapid RR, pulse of 80%, wheezing/crackles, all the symptoms of fluid overload. After lasix administered, symptoms resolve, and I document my new assessment accordingly (at the time the symptoms resolve... So not in the column of my initial 19:30 assessment). Oncoming nurse copies and pastes my initial 19:30 assessment. So the patient developed fluid overload again? Because that's what "her" assessment looked like.

I also document a lot of interventions in my initial assessment since I try to cluster my care. Wound care, PICC dressing changes, ambulation, ect... That if copied/pasted by the next nurse look like they did them on their shift as well. Falsification of documentation if they actually weren't done on her shift.

I see (and have made) entries on the wrong patients chart. It's easy to have two tabs open and document on the wrong one.

[jadelpn, LPN, EMT-B]

Computer charting doesn't give a whole lot of room to elaborate or make extra notes. It seems like the bare minimum needed to "make it legal".

Nurses can start to glaze over with the 523 individual checkboxes that one has to go through. They may be user friendly, but after the 15th page, accuracy can become an issue.

What becomes a HUGE issue, and that I have seen nurse's get in hot water over is the lack of checking the box off for "patient education" THIS is one of the goals of the facility as it counts towards "meaningful use" which means that if a nurse does not do this, the facility will not get the max governmental reimbursement for converting to EMR's.

Seems as if no one cares if the infomation is accurate (unless they are caught in the act) but everyone is up in arms that the appropriate boxes are checked so they get paid.

[nurse4me8897]

Most data shows that EMR's have reduced errors, and that is partly true. However, EMR's have also introduced a host of new errors that were never a factor with hand written charts. Mistakes are being made in entirely new ways now. My focus is to highlight the areas where these new errors are being made and bring it to nurses attentions so that the errors can be prevented. Drop down menus, scanning, electronic signatures, computer glitches...the list goes on. I am not preaching against EMR's, just trying to increase awareness of new responsibilities.